COMPARISON OF FGF -8, FGF -10, FGF- RECEPTOR 2,
ANDROGEN RECEPTOR, ESTROGEN RECEPTOR-Α
AND SS IN HEALTHY AND HYPOSPADIAC CHILDREN
Emaratpardaz N, Turkyilmaz Z, Karabulut R, Dayanir D, Kaya C, Sert AAE, Arkan G, Ucaner FA, Kapisiz A, Eryilmaz S, Atan A, Sonmez K
*Corresponding Author: Prof. Ramazan Karabulut, MD, Gazi University Faculty of Medicine,
Department of Pediatric Surgery, Besevler, 06550, Ankara-Turkey. Tel: +90 312 2026210;
Fax: +90 312 2230528. E-mail: karabulutr@yahoo.com, ramazank@gazi.edu.tr
page: 21
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INTRODUCTION
Hypospadias is a genital anomaly characterized by
the location of the external urethral meatus on the ventral
side of the penis, in the scrotum, or perineum, affecting
approximately one in every 200-300 boys. It is considered
to be the most common congenital anomaly after unde-
scended testis in boys [1,2]. There are many classifications
for hypospadias. According to Duckett’s classification,
which is widely used by pediatric surgeons, hypospadias
is classified as proximal and distal. In distal hypospadias,
detected in approximately 70% of cases, the urethral me-
atus may be located in the glandular area, coronal area,
and distal shaft of the penis. In proximal hypospadias,
which is detected in approximately 30% of cases, the ure-
thral meatus may be located in the middle penile region,
proximal penile shaft, penoscrotal or perineal regions [3].
Investigations of genetic, endocrine and environmental
factors in the etiology of hypospadias are still ongoing.
Studies on the effects of environmental and endocrine
factors have shown that factors such as small gestational
age (SGA), placental insufficiency, maternal hypertension,
preeclampsia, antiepileptic drugs use, multiple pregnancy,
gestational diabetes, maternal obesity often play an effec-
tive role in the etiology of hypospadias [4]. Although many
genetic syndromes include hypospadias, hypospadias due
to genetic causes accounts for less than 10% of all cases.
The risk of developing hypospadias in a brother of a pa-
tient with hypospadias is more than 10% [5]. Although
it is known that the frequency of proximal hypospadias
increases with some syndromes, there is usually sporadic
occurrence for distal hypospadias. It has been shown that
the expression of some genes and defects in androgen and
estrogen production in the genital tubercle and urethral
plate may also be effective in the etiology of hypospadias (SHH, ER1, ER2, GL1, GL2, GL3, ATF3, FGF-8, FGFR-
2, VAMP7, WT1, BMP7, WNT5A), DGKK etc.) [5,6]. It
is known that Fibroblast Growth Factors (FGF) have a
very important contribution to the fusion of the urethral
folds and the development of the genital tubercle, and
play a role in wound healing and tissue regeneration [7].
Additionally, androgen receptors (AR) are also found to
play an important role in male sexual differentiation with
the effect of gonadal androgens. Decreased expression of
AR has also been reported to have consequences such as
infertility, testicular atrophy, micropenis, hypospadias,
and decreased sperm production. The decreased response
to human chorionic gonadotropin (hCG) stimulation in
children with hypospadias points to the importance of this
receptor in the etiology of hypospadias [8]. Studies have
found that there were significant differences in terms of
estrogen receptors (ERs) in the foreskins of children with
or without hypospadias, and these data showed that this
difference may play a role in the etiology of hypospadias
[9,10,11]. As well as the surgical treatment of hypospa-
dias, investigation into ways of preventing the disease has
gained importance due to its increasing prevalence [12].
Prevention of hypospadias or medical treatment research
is important to prevent psychosexual problems of the pa-
tients due to possible chordee, fistula and poor cosmetic
results that may occur in adulthood after surgical treatment
applied in childhood.
In this study, levels of fibroblast growth factor 8
(FGF-8), FGF-10, FGF Receptor-2 (FGFR-2), AR, ER-α
and ER-ß were compared in order to discover the etiology
of hypospadias in foreskin tissues of children with and
without hypospadias.
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