The role of testicular ultrasonography as a screening tool for testicular dysfunction in hypospadias

Objectives To explore the association between hypospadias and morphological testicular abnormalities, assessed through testicular ultrasonography, focusing on microcalcifications and parenchyma inhomogeneity. Patients and Methods We conducted a cross‐sectional case–control study, in which testicular ultrasonography in 244 males born with hypospadias (Tanner 1: n = 17; Tanner 2–4: n = 27; Tanner 5: n = 200) and 51 controls (all Tanner 5) was analysed by three physicians. Homogeneity and microcalcifications were scored on a four‐point and three‐point Likert scale, respectively. Associations were sought with clinical data and maternal, dietary and substance factors. Results Substantial interobserver agreement was found (microcalcifications: κ = 0.735; inhomogeneity: κ = 0.647). Testicular inhomogeneity was more common in patients with all forms of hypospadias compared to controls (overall: P = 0.004; mild: P = 0.006; severe: P < 0.001; complex hypospadias: P < 0.001) and increased with puberty progression. Associations were found with reduced sperm concentration, number of penile surgeries, shorter adult stretched penile length, being born small for gestational age, and unhealthy lifestyle. The positive and negative predictive values of inhomogeneity for oligozoospermia and azoospermia were 29.6% and 84.8%, respectively. No difference in the prevalence of testicular microcalcifications was found compared to controls ( P = 0.599). Conclusion Testicular parenchymal inhomogeneity was more common in men born with hypospadias and was associated with testicular, surgical and prenatal factors. Therefore, testicular inhomogeneity could serve as a relevant, non‐invasive supporting marker to identify who could benefit from andrological evaluation. Screening may be recommended from late puberty as the first morphological changes are typically observed at this stage.