Recent advances in hypospadias: current surgical technique and research in incidence and etiology.

Surgical techniques to repair hypospadias have undergone remarkable advances in recent years with the development and widespread use of dorsal urethral plate incision to facilitate urethroplasty. Clinical studies of the technique have shown excellent cosmesis and low complication rates for dorsal plate incision (DPI) in distal hypospadias repair, and have demonstrated the efficacy of expanding the use of the DPI in conjunction with other surgical techniques in more proximal repairs. There have been reports of increasing overall incidence of hypospadias in Scandinavian and US populations, but this might not be a uniform trend. There is, in fact, wide variation in the reported incidence of hypospadias among different countries. Many countries have not shown increased rates of hypospadias; furthermore, in countries noted previously to have an increased incidence of hypospadias, rates have leveled off since 1985. Investigations into the etiology of hypospadias have shown potential links to estrogen effects in utero from increased phytoestrogen intake in maternal vegetarian diets, and rare cases of genetic mutations in 5-alpha reductase type II.