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Rising hypospadias rates: disproving a myth

Fisch, Harry; Hyun, Grace; Hensle, Terry W
Hypospadias is one of the most common congenital abnormalities occurring in males. In recent years, the prevalence of hypospadias and whether that prevalence is rising or stable has become part of a larger debate over the potential effects of so-called 'endocrine disruptors', such as phthalates and bisphenol-A, on male reproductive health. This commentary critically examines allegations suggesting a worldwide increase in hypospadias rates. Despite the lack of scientific support for this hypothesis and for related claims that the disorders of male reproductive health are related to endocrine disruptors, these constructs remain firmly entrenched in popular literature, and are being used in part to justify litigation banning suspected endocrine disruptors such as phthalates and bisphenol-A. A review of the epidemiologic data on this issue amassed to date clearly demonstrates that the bulk of evidence refutes claims for an increase in hypospadias rates. This suggests that two of the three components of alleged testicular dysfunction syndrome, i.e. decline in sperm counts and rise in urogenital anomalies, lack clinical support. It further suggests that extrapolations from data derived in laboratory animal studies about alleged occult risks to humans of various candidate compounds are unwarranted at this time.
PMID: 20022563
ISSN: 1873-4898
CID: 2699642

Hypospadias rates in new york state are not increasing

Fisch, Harry; Lambert, Sarah M; Hensle, Terry W; Hyun, Grace
PURPOSE: The testicular dysgenesis syndrome describes urogenital abnormalities associated with exposure to environmental endocrine disruptors such as phthalates, specifically decreased semen quality, and increased rates of testis cancer and hypospadias. Recently there has been concern that these abnormalities described in animal studies may also be present in humans. To determine if hypospadias rates are increasing, we retrospectively reviewed the total prevalence of hypospadias in New York State from 1992 to 2005, categorized by maternal age younger than 35 years and 35 years or older. MATERIALS AND METHODS: Hypospadias rates were obtained from the New York State Congenital Malformations Registry from 1992 to 2005. An analysis was also performed on the rates of children with hypospadias who had mothers younger than 35 years and mothers 35 years or older. This investigation was approved by the Columbia University internal review board. RESULTS: There was no statistical change in hypospadias rates in New York State from 1992 to 2005 (r = 0.127, p = 0.6). Overall the mean +/- SE prevalence rate was 34.9 +/- 0.36 per 10,000 live births. However, mean +/- SE hypospadias rates in children of mothers 35 years old or older (38.7 +/- 0.7) were significantly greater than those in children of mothers younger than 35 years (34.1 +/- 0.386, t test p <0.01). CONCLUSIONS: Hypospadias rates have not changed in New York State from 1992 to 2005. Additionally advanced maternal age continues to be a risk factor for hypospadias. Combined with previous studies that demonstrate sperm counts are not declining, these data suggest that the testicular dysgenesis syndrome described in animal models may not be evident in humans.
PMID: 19303092
ISSN: 1527-3792
CID: 2699652

Part 2: Examining pediatric vesicoureteral reflux: a real-world evaluation of treatment patterns and outcomes

Hensle, Terry W; Hyun, Grace; Grogg, Amy L; Eaddy, Michael
OBJECTIVE: Vesicoureteral reflux (VUR) occurs in 1% of infants and children. Upon diagnosis, patients are often placed on prophylactic antibiotics to prevent urinary tract infections (UTIs) and potential renal damage. The objective of this study was to assess current diagnosis and treatment patterns for patients diagnosed with VUR, focusing on compliance with antibiotic therapy and the occurrence of UTIs. METHODS: This is a retrospective study of children less than 11 years of age diagnosed with VUR. Data were obtained from a national managed care database with over 45 million lives. Patients were followed for up to 6 months prior to their diagnosis and 1 year after. All were required to be eligible for medical and pharmacy services for 1 year after diagnosis. Outcome measures included the use of and compliance with prophylactic antibiotics, rates of curative treatment (surgery and endoscopic injections), and diagnoses of UTIs. RESULTS: There were 35 450 patients meeting inclusion criteria. After being diagnosed with VUR, 76.5% of patients were placed on prophylactic antibiotics, 1.5% had open surgery, and 0.38% had an endoscopic injection with dextranomer/hyaluronic acid copolymer (Dx/HA). Only 17% of patients on prophylactic antibiotics were adherent to therapy, with mean patient compliance equaling 41.4%. Of patients on prophylactic antibiotic therapy, 58% still had a diagnosis for a UTI within 12 months of VUR diagnosis. LIMITATIONS: Adherence to VUR-related antibiotic therapy may be overestimated as the data used in the analysis represents prescriptions acquired but not necessarily consumed. This study lacked detailed clinical information, such as VUR-resolution rates and VUR grade. CONCLUSIONS: Only 17% of pediatric VUR patients on prophylactic antibiotics were compliant with therapy. Of patients on prophylactic therapy, 58% had a diagnosis of a UTI within 1 year of treatment.
PMID: 17931479
ISSN: 1473-4877
CID: 2699662

Transperitoneal laparoscopic pyeloplasty for pelvic kidneys with ureteropelvic junction obstruction in children: technique and preliminary outcomes

Schwab, C William 2nd; Hyun, Grace; Garibay-Gonzalez, Francisco; Canning, Douglas A; Grady, Richard W; Casale, Pasquale
BACKGROUND: Laparoscopic pyeloplasty is rapidly becoming an acceptable procedure for ureteropelvic junction obstruction in the pediatric population. We present our experience with transperitoneal laparoscopic pyeloplasty for ureteropelvic junction obstruction in pelvic kidneys in pediatric patients. METHODS: A transperitoneal laparoscopic approach was used for performing a pyeloplasty in 4 patients, 7 months to 8 years of age (mean age, 3.14), with ureteropelvic junction obstruction in a pelvic kidney. RESULTS: Average operative time was 2.1 hours (range, 1.5 to 2.8). Mean hospital stay was 2.15 days (range, 1 to 7). No intraoperative complications were noted. CONCLUSIONS: Transperitoneal laparoscopic pyeloplasty for pelvic kidneys is feasible in the pediatric population, and preliminary results appear to offer the same outcome as that seen in orthotopic kidneys.
PMID: 17212885
ISSN: 1086-8089
CID: 2699672

Examining pediatric vesicoureteral reflux: A real-world evaluation of treatment patterns and outcomes [Meeting Abstract]

Hensle, TW; Hyun, G; Grogg, A; Eaddy, M
ISSN: 0022-5347
CID: 2699792

Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems

Gonzalez, Francisco; Canning, Douglas A; Hyun, Grace; Casale, Pasquale
OBJECTIVE: To determine the incidence and efficacy of treatment for pelvi-ureteric junction obstruction (PUJO, the most common cause of hydronephrosis in the fetal kidney) in duplicated systems. PATIENTS AND METHODS: We retrospectively assessed patients with PUJO in a duplex collecting system, reviewing each case for age, sex, anatomy, presenting symptoms and type of management. RESULTS: From 1994 to 2004, 1413 patients were identified to have hydronephrosis; 243 of them had pyeloplasty for PUJO, and five (2%) involved the lower pole of a duplicated collecting system. In two of the patients the presentation was prenatal hydronephrosis (mean age at diagnosis 6 weeks) and the remainder presented with flank pain and pyelonephritis (mean age 5 years); all were boys. There was only one incomplete duplication (Y type). Four patients had a dismembered pyeloplasty and one a ureteric calycostomy. Vesico-ureteric reflux was present in three patients and two required common sheath reimplantation. On a radioisotope scan during the follow-up (mean 12 months) the five patients showed an improvement and no evidence of functional obstruction. CONCLUSION: The incidence of PUJO in duplicated systems was 2%; treatment should be individualized and requires a careful preoperative evaluation. This anomaly appears to be more common in boys and in completely duplicated systems.
PMID: 16336349
ISSN: 1464-4096
CID: 2699682

A practical approach to intersex in the newborn period

Hyun, Grace; Kolon, Thomas F
Sexual determination is a complex process that occurs in an organized sequential manner. When chromosomal, gonadal, or phenotypic sex determination goes awry,intersexuality develops. Advances in molecular biology have made it easier to understand the various phenotypes that are encountered. It is easy to be overwhelmed when reviewing the testosterone synthesis pathway and the intersex differential diagnosis. This article presents a useful approach to the evaluation of the newborn with ambiguous genitalia.
PMID: 15313053
ISSN: 0094-0143
CID: 2699692

Transfection of bladder smooth muscle cells with telokin alters their smooth muscle phenotype [Meeting Abstract]

Hyun, G; Chang, SH; Zderic, SA; Wein, AJ; Chacko, S; DiSanto, ME
ISSN: 0022-5347
CID: 2699782

Telokin expression is associated with urinary bladder smooth muscle phenotype [Meeting Abstract]

Hyun, G; Dave, R; Zderic, SA; Chacko, S; DiSanto, ME
ISSN: 0006-3495
CID: 2699772

Endocrine evaluation of hypospadias

Hyun, Grace; Kolon, Thomas F
PMID: 15086019
ISSN: 0065-2598
CID: 2699702