Hypospadias and the Use of the Ages and Stages Questionnaire to Evaluate Neurodevelopmental Status of Boys with Hypospadias

Abstract

Introduction Placental insufficiency is one of the reasons for the reduction of hormone production. Thus, if one of the suspected causes of hypospadias is placental insufficiency, then the neurodevelopmental status of boys with hypospadias may be impaired. The aim of this study was to evaluate the neurodevelopmental status of boys with hypospadias and guide the parents of those who need support to related departments for early intervention.

Materials and Methods Boys were divided into two groups, those with hypospadias (group H) and healthy children undergoing traditional circumcision (group C). The parents of the boys completed the Ages and Stages Questionnaire (ASQ) and ASQ–Social Emotional (SE), both of which are screening instruments for the early identification of developmental and social–emotional problems, respectively.

Results Seventy-eight boys had hypospadias and 59 were admitted for traditional circumcision. The group H had statistically significant more impaired scores than group C in communication, gross motor, and personal–social skill sections. The multivariate logistic regression analysis revealed that hypospadias was the independent predictive factor for communication and personal–social skills.

Conclusion Hypospadias and neurologic impairment may share common etiologic factors. Accordingly, physicians should keep in mind that if a boy presents with hypospadias, the possibility of having neurologic impairment is higher than normal population and early intervention has crucial importance. Every boy with hypospadias should be evaluated for neurodevelopmental status.

Keywords

child behavior - child development - etiology - hypospadias

• References

• 1 Springer A, van den Heijkant M, Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol 2016; 12 (03) 152.e1-152.e7
• 2 Fujimoto T, Suwa T, Kabe K, Adachi T, Nakabayashi M, Amamiya T. Placental insufficiency in early gestation is associated with hypospadias. J Pediatr Surg 2008; 43 (02) 358-361
• 3 Candel-Pau J, Perapoch López J, Castillo Salinas F, Sánchez Garcia O, Pérez Hoyos S, Llurba Olivé E. Neurodevelopment in preterm infants with and without placenta-related intrauterine growth restriction and its relation to perinatal and postnatal factors. J Matern Fetal Neonatal Med 2016; 29 (14) 2268-2274
• 4 Folger AT, Ding L, Ji H. et al. Neonatal NR3C1 methylation and social-emotional development at 6 and 18 months of age. Front Behav Neurosci 2019; 13: 14
• 5 Rana N, Kc A, Målqvist M, Subedi K, Andersson O. Effect of delayed cord clamping of term babies on neurodevelopment at 12 months: a randomized controlled trial. Neonatology 2019; 115 (01) 36-42
• 6 Squires J, Elizabeth T, Bricker D, LaWanda P. Ages & Stages Questionnaires, (ASQ-3): A Parent-Completed Child-Monitoring System. ASQ-3 User's Guide. 3rd ed.. Baltimore, MD: Brookes Publishing Company; 2009
• 7 Bricker D, Squires J, Mounts L. et al. Ages and Stages Questionnaires: A Parent-Completed Child Monitoring System. 2nd ed.. Baltimore, MD: Brookes Publishing Company; 1999
• 8 Kapci EG, Kucuker S, Uslu RI. How applicable are ages and stages questionnaires for use with Turkish children?. Top Early Child Spec Educ 2010; 30 (03) 176-188
• 9 Kucuker S, Kapci EG, Uslu RI. Evaluation of the Turkish version of the “ages and stages questionnaires: Social-emotional” in identifying children with social-emotional problems. Infants Young Child 2011; 24 (02) 207-220
• 10 Butwicka A, Lichtenstein P, Landén M. et al. Hypospadias and increased risk for neurodevelopmental disorders. J Child Psychol Psychiatry 2015; 56 (02) 155-161
• 11 Carmichael SL, Shaw GM, Lammer EJ. Environmental and genetic contributors to hypospadias: a review of the epidemiologic evidence. Birth Defects Res A Clin Mol Teratol 2012; 94 (07) 499-510
• 12 Carmichael SL, Witte JS, Ma C, Lammer EJ, Shaw GM. Hypospadias and variants in genes related to sex hormone biosynthesis and metabolism. Andrology 2014; 2 (01) 130-137
• 13 Kalfa N, Paris F, Soyer-Gobillard MO, Daures JP, Sultan C. Prevalence of hypospadias in grandsons of women exposed to diethylstilbestrol during pregnancy: a multigenerational national cohort study. Fertil Steril 2011; 95 (08) 2574-2577
• 14 Bauer SB, Retik AB, Colodny AH. Genetic aspects of hypospadias. Urol Clin North Am 1981; 8 (03) 559-564
• 15 Marrocco G, Grammatico P, Vallasciani S. et al. Environmental, parental and gestational factors that influence the occurrence of hypospadias in male patients. J Pediatr Urol 2015; 11 (01) 12-19
• 16 Yang Q, Qu WY, Yang L, Wang K, Tu HY, Wang J. Literature on the aetiology of hypospadias in the last 5 years: molecular mechanism and environmental factors. Andrologia 2014; 46 (06) 583-591
• 17 Brouwers MM, van der Zanden LFM, de Gier RPE. et al. Hypospadias: risk factor patterns and different phenotypes. BJU Int 2010; 105 (02) 254-262
• 18 Buckley J, Willingham E, Agras K, Baskin LS. Embryonic exposure to the fungicide vinclozolin causes virilization of females and alteration of progesterone receptor expression in vivo: an experimental study in mice. Environ Health 2006;5(04):
• 19 Huisma F, Thomas M, Armstrong L. Severe hypospadias and its association with maternal-placental factors. Am J Med Genet A 2013; 161A [phone]
• 20 Miller SL, Huppi PS, Mallard C. The consequences of fetal growth restriction on brain structure and neurodevelopmental outcome. J Physiol 2016; 594 (04) 807-823
• 21 Chen YF, Huang WY, Huang KH, Hsieh JT, Lan CF, Chang HC. Factors related to the time to cryptorchidism surgery--a nationwide, population-based study in Taiwan. J Formos Med Assoc 2014; 113 (12) 915-920
• 22 Toufaily MH, Roberts DJ, Westgate MN, Hunt AT, Holmes LB. Hypospadias, intrauterine growth restriction, and abnormalities of the placenta. Birth Defects Res 2018; 110 (02) 122-127
• 23 Duby JC, Lipkin PH, Macias MM. et al; Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics 2006; 118 (01) 405-420
• 24 Nordhov SM, Rønning JA, Ulvund SE, Dahl LB, Kaaresen PI. Early intervention improves behavioral outcomes for preterm infants: randomized controlled trial. Pediatrics 2012; 129 (01) e9-e16
• 25 Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics 2010; 126 (05) e1088-e1094
• 26 Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol 1997; 22 (03) 313-328
• 27 Skellern CY, Rogers Y, O'Callaghan MJ. A parent-completed developmental questionnaire: follow up of ex-premature infants. J Paediatr Child Health 2001; 37 (02) 125-129
• 28 Noeder MM, Logan BA, Struemph KL. et al. Developmental screening in children with CHD: Ages and Stages Questionnaires. Cardiol Young 2017; 27 (08) 1447-1454
• 29 Rogers EE, Hintz SR. Early neurodevelopmental outcomes of extremely preterm infants. Semin Perinatol 2016; 40 (08) 497-509
• 30 Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. Lancet Neurol 2009; 8 (01) 110-124
• 31 Volpe JJ. The encephalopathy of prematurity--brain injury and impaired brain development inextricably intertwined. Semin Pediatr Neurol 2009; 16 (04) 167-178
• 32 Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: Comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976
• 33 Sandberg DE, Meyer-Bahlburg HFL, Aranoff GS, Sconzo JM, Hensle TW. Boys with hypospadias: a survey of behavioral difficulties. J Pediatr Psychol 1989; 14 (04) 491-514
• 34 Berg R, Berg G, Svensson J. Penile malformation and mental health. A controlled psychiatric study of men operated for hypospadias in childhood. Acta Psychiatr Scand 1982; 66 (05) 398-416