Histopathological Profiling of the Urethral Plate in Hypospadias Patients.

Abstract

Background: Hypospadias is a congenital anomaly characterized by ectopic placement of the urethral meatus on the ventral surface of the penis. Surgical manipulation of the urethral plate during urethroplasty induces tissue injury and wound-healing responses that may lead to fibrosis and altered tissue remodeling. However, histopathological differences of the urethral plate between distal and proximal hypospadias remain incompletely characterized.

Methods: This retrospective analytical study included pediatric patients with hypospadias who underwent primary surgical repair between 2013 and 2023. Urethral plate specimens excised from the dartos fascia to the tunica albuginea were collected intraoperatively and examined histopathologically. Hematoxylin-eosin and Masson trichrome staining were used to assess fibrosis severity, collagen density, and inflammatory cell infiltration. Associations between histopathological parameters and hypospadias type were analyzed statistically.

Results: A total of 96 patients met the inclusion and exclusion criteria and were included in the analysis. Fibrosis severity was significantly associated with hypospadias type (P = .028), with distal hypospadias demonstrating a higher risk of moderate to severe fibrosis compared with proximal hypospadias (risk ratio, 2.56; 95% CI, 1.098-5.97). In contrast, no significant differences were observed between distal and proximal hypospadias with respect to collagen density or inflammatory cell infiltration.

Conclusions: Fibrosis severity of the urethral plate differs significantly between distal and proximal hypospadias, indicating that fibrotic remodeling represents a distinct histopathological feature associated with hypospadias severity. Collagen density and inflammatory cell presence did not differ significantly between groups. These findings may have implications for surgical planning and tissue handling in hypospadias repair.