Prenatal diagnosis of severe hypospadias with two- and three-dimensional sonography

Hypospadias is a birth defect found in boys in whom the urinary tract opening is not at the tip but on the ventral side of the penis. The estimated prevalence of hypospadias is between 0.2 and 4.1 per 1000 live births of both sexes.(1,2) Urologic classification of hypospadias is based on meatal position: anterior (glandular or coronal), occurring in approximately 50%; middle (penile shaft), constituting 30%; and posterior, accounting for the remaining 20%. A posterior location may occur at the penoscrotal junction, within the scrotum, or along the perineum.(3) In the case of hypospadias, ventral curvature of the penis may be observed and is known as the chordee. The chordee is caused by atresia of the corpus spongiosum distal to the hypospadiac urethral meatus.(4) Prenatal diagnosis of hypospadias has been reported previously. (5-14) Recently Meizner(15) reported 7 cases of severe hypospadias. In 6 of these cases, a specific sign called the "tulip sign" was described.(15) We present a case of severe hypospadias in which three-dimensional (3D) sonography was used to better define the tulip sign after recognition on two-dimensional sonography.