title: Age of the mother as a risk factor and timing of hypospadias repair according to severity.
abstract: OBJECTIVE
  Hypospadias is characterized by a displacement of the urethral opening in males that can change from the typical position within the glans penis to a subcoronal position (Type I), to anywhere along the ventral shaft (Type II), to penoscrotal, scrotal, or perineal positions (Type III). We and others have previously reported that age of the mother (≥ 40 years old) is a risk factor for having a child with hypospadias, but there is a scarcity of reports on whether such risk is higher for having a child with the mild (Type I) or the more severe forms (Types II and III). In addition, we aimed to assess the timing of hypospadias repair according to severity.
  
  
  METHODS
  Parents of children with hypospadias were interviewed by using a series of questionnaires (n = 128 cases). Severity was confirmed in the clinic and age of the mother was self-reported. Number of surgeries, age of child by the first and the last intervention was also assessed. Ordered logistic regression and the Brant test were employed to calculate risk between mild (Type I) and severe cases (Types II and III), and the assumption of proportional odds, respectively. The Mann-Whitney U Test was used to compare number of surgeries and age by the last repair between mild and severe cases. One-way ANOVA was employed to compare age of the child at the time of first surgery across severities (Types I - III).
  
  
  RESULTS
  Women ≥ 40 years of age are 3.89 times [95% CI: 1.20-12.64] at a higher risk for having a child with the more severe forms of the condition than younger women. Repair of Type I was accomplished with 1 intervention whereas more severe cases required 1 - 4 (2 ± 0.5) surgical interventions. The timing for hypospadias repair of Type I cases occurred at an average age of 16.2 ± 4.88 months, of Type II cases occurred at an average age of 20.3 ± 8.15 months whereas the average age of the first hypospadias repair among Type III cases was 12.68 ± 2.52 months. Number of surgeries according to severity (p ≤ 0.0018, z-ratio = 2.91) and age difference for the timing of last repair (p ≤ 0.045, z-ratio = 1.69) were statistically different, but not the age difference for the first repair.
  
  
  CONCLUSIONS
  Increased maternal age is associated with the most severe forms of hypospadias. There is room for improvement for the timing of hypospadias repair according to severity.
authors.affiliation: Department of Anatomy and Neurobiology, Officer of Diversity and Inclusion, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Jorge
authors.affiliation: Division of Urology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Marcos Raymond
authors.initials: MR
authors.lastname: Pérez-Brayfield
authors.affiliation: MD program, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Camille M
authors.initials: CM
authors.lastname: Torres
authors.affiliation: Department of Anatomy and Neurobiology, PhD Program, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Coriness
authors.initials: C
authors.lastname: Piñeyro-Ruiz
authors.affiliation: Biology Program, Rio Piedras Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Naillil
authors.initials: N
authors.lastname: Torres
keywords: Hypospadias; Hypospadias repair; Hypospadias risk; Hypospadias severity; Maternal age