Urbanization and incidence of hypospadias

Background Hypospadias is one of the most common congenital malformations in boys, with rising incidence worldwide. Environmental factors, including endocrine disruptors, are suspected to play a role. This study aimed to assess the association between urbanization level and the incidence and severity of hypospadias in the Poitou-Charentes region (France) between 2018 and 2021. Methods A retrospective monocentric study was conducted at Poitiers University Hospital. Demographic and clinical data from 117 patients included were collected. Maternal residence during pregnancy was categorized as urban or rural based on INSEE classifications. Hypospadias severity was classified into four groups. Incidence was calculated according to municipality birth data, and group comparisons were performed using the Kruskal–Wallis test ( p < 0.05). Results The incidence of hypospadias was significantly higher in rural areas compared to urban areas (0.0020 vs. 0.0018; p < 0.001). Minor forms (balanitis and balanopreputial) predominated in rural areas, whereas severe forms (penile and scrotal) were more frequent in urban settings. Conclusion Our findings suggest potential differences in hypospadias incidence and severity between rural and urban areas, which may reflect differential exposure to environmental pollutants such as pesticides and industrial compounds. While causal inference is not possible given the observational design, these results support increased vigilance regarding endocrine disruptor exposure during pregnancy.