Endocrine Abstracts

The occurrence of hypospadias remains unexplained in most cases. A complex, multimodal environment is likely involved in the development of genital malformations. Beyond contributing to the occurrence of the malformation, this environment also influences its prognosis. The genetic environment classically involves genes responsible for gonadal development, hormone biosynthesis, and hormonal sensitivity. Additionally, genes involved in cell adhesion and placental development may constitute a favorable or unfavorable background, potentially affecting respectively postoperative complications or growth restriction in these children. The hormonal environment, a key etiological factor, may also serve as a prognostic determinant in the management of these children. A deficiency in androgen synthesis or action affects the overall development of the genital tubercle, glans diameter, and possibly urethral plate width, all of which are prognostic factors for postoperative complications. The external environment, suspected to contribute to the occurrence of hypospadias through the action of endocrine disruptors chemicals, may also alter tissue healing and increase the rate of post-operative complications. Finally, the surgical environment determines prognosis. Center surgical volume, national organization into referral centers, and multidisciplinary management all influence the overall outcome of care in children with hypospadias. Overall, hypospadias should be understood within a multifactorial framework in which genetic, hormonal, environmental, and surgical factors interact. These interconnected environments not only contribute to the occurrence of the malformation but also shape its phenotypic severity and influence key anatomical determinants relevant to repair, thereby impacting prognosis and surgical outcomes.