Proximal Hypospadias and Risk of Acquired Cryptorchidism

Purpose: We hypothesized that boys with proximal hypospadias are at increased risk for acquired cryptorchidism. Materials and Methods: We retrospectively studied the records of 114 boys who underwent repair for proximal hypospadias and had at least 1 year of followup, and 342 age matched boys receiving well child examinations. We used chi-square analysis to determine if cryptorchidism prevalence differed between the cohorts. Association between predictor (presence and severity of hypospadias, ethnicity/race, age, medical comorbidities) and outcome (acquired cryptorchidism, primary cryptorchidism, retractile testes) variables was modeled using univariate analysis and multivariate logistic regression. Results: A total of 22 subjects (19%) with hypospadias had 26 nonscrotal testes, of which 2 (2%) represented primary cryptorchidism, 16 (14%) acquired cryptorchidism and 8 (7%) retractile testes. A total of 12 controls (3.5%) had 15 nonscrotal testes, of which 6 (1.8%) represented primary cryptorchidism, 1 (0.3%) acquired cryptorchidism and 8 (2.3%) retractile testes. Children with hypospadias had a higher prevalence of acquired cryptorchidism and retractile testes (all p < 0.05). Hypospadias (OR 60.67, 95% CI 7.79-472.80) and increasing age (OR 1.02, 95% CI 1-1.03) were associated with development of acquired cryptorchidism. Hypospadias was associated with development of retractile testes (OR 3.11, 95% CI 1.4-8.50), and greater severity of hypospadias correlated with development of acquired cryptorchidism (p = 0.01). Conclusions: Boys with a history of severe hypospadias are at increased risk for acquired cryptorchidism and retractile testes. The risk of acquired cryptorchidism increases directly with hypospadias severity. We suggest that the role of prenatal and postnatal androgen disruption, which may link these conditions, be explored further.