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Hypospadias is a common congenital condition of the urethra in newborn males, appearing in as many as 1 in 300 infants.
The incidence of bladder exstrophy, the improper formation of the bladder on the lower abdominal wall, varies in different parts of the world, but occurs in approximately 1 in 30,000 live births and is slightly more common in boys than in girls.
Vesicoureteral reflux (VUR) is a birth defect in which urine travels backward from the bladder toward the kidney and may affect one or both ureters. VUR occurs in about 1% of healthy children.
Hydrocele, an accumulation of fluid within the tunica vaginalis, the thin sac that holds the testicles within the scrotum, is present in about 10% to 20% of all full-term male births.

Many patients ranging from fetal stage through late adolescence are brought to the Johns Hopkins Children''s Center each year specifically because of the remarkable success the doctors have achieved in rehabilitating children who have failed initial genitourinary surgery elsewhere, especially for bladder exstrophy. Johns Hopkins pediatric surgeons treat more children with this major birth defect than do physicians at any other institution in the world. Our experts also manage all congenital urologic issues in children and have advanced the use of minimally invasive surgery for the undescended testis as well as kidney and bladder stones in children. The medical and surgical management of urinary incontinence in children has been furthered by clinical studies through a dedicated voiding improvement program and improvement in surgical reconstruction technique.

John P. Gearhart, M.D., Professor and Director of Pediatric Urology at the Johns Hopkins Children’s Center, along with his fellow pediatric urological team members, has extensive experience in urological reconstruction.

Dr. Gearhart's current research is focused on generating new knowledge based on the evaluation and treatment of the bladder muscle, nerve supply, and collagen content of the exstrophic bladder. In addition, long-term follow-up studies are underway of patients born with ambiguous genitalia. Dr. Gearhart, and other colleagues, is studying the effect of high-soy diets (which supply increased estrogen) and the worldwide increase in the incidence of hypospadias.

Our laboratory was the first in the world to show the connection between the breakdown products of soy and hypospadias development. When it opens in 2009, the new Johns Hopkins Children's Center, a 560,000 square foot, $275 million state-of-the-art facility will allow us to continue providing our patients and their families with the best care possible.