ESPE Abstracts (2019) 92 P2-247

Does the Anogenital Distance Predict Outcome of Hypospadias Repair?

Alexander Springer1, Stefan Riedl2, Ursula Tonnhofer1, Manuela Hiess3, Martin Metzelder1, Doris Hebenstreit4


1Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria. 2Department of Pediatrics, Medical University Vienna, Vienna, Austria. 3Department of Urology, Medical University Vienna, Vienna, Austria. 4Department of Urology, Hanusch Krankenhaus, Vienna, Austria


Purpose: The anogenital distance (AGD) is androgen action dependent. It is sexually dimorphic and seems to be shorter in androgen-action related diseases like hypospadias. In this study we sought to determine whether the AGD is predictive for surgical outcome in hypospadias repair.

Material and Methods: Patients were collected prospectively. AGD was measured in OR prior to surgery by 2 surgeons (blinded, each 3 times). Outcome parameters were definded as: 1.) complications (fistula, breakdown, glans dehiscence, redo surgery) and 2.) need for staged repair. There were 208 prepubertal boys: 119 controls 2.38yrs (0.02-10.2) and 89 hypospadias (55 distal hypospadias 2.74yrs (0.07-9.67) and 34 proximal hypospadias 2.45yrs (0.58-9.76). Mean follow- up was 1.1yrs.

Results: There was no difference in AGD in controls and mild hypospadias. Severe hypospadias had a significantly shorter AGD (P=0.003). AGD was significantly shorter in patients undergoing staged repair (37mm vs. 26mm, P=0.001). AGD was significantly shorter in patients who developed postoperative complications (38mm vs. 29mm, P=0.04).

Conclusions: Shorter AGD predicts higher complication rate and the need for more extensive surgery. Hypothetically, a short AGD resembles impaired intra uterine androgen action (low androgens, androgen receptor problems, counteracting endocrine disruptors, and unknown genetic androgen interaction). These fetal androgen deficiencies may be reflected in hypospadias minor tissue quality resulting in delayed wound healing, inflammation and a higher complication rate or more difficult surgery resulting in staged repair.

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