Ultrasonographic Diagnosis of Fetal Hypospadias

Round 1

Reviewer 1 Report

The authors present 4 cases of antenatally diagnosed hypospadias. 3 of these have been confirmed after birth.  In general, the topic is interesting. However, I would suggest some changes:

There are several doppler images of the urinary stream in hypospadias but no images of normal flow pattern to compare with. I think it would be helpful to have normal images to compare with.

All postnatal images are really poor quality. Please resubmit better ones.

Also, majority of images do not have arrows pointing to the abnormal finding even thoug figure legends state otherwise. Arrows missing in Figure 2, 3, 5, 6 and 7.

General comments: Do the  the authors have some recommendations for antenatal screening regarding hypospadias?

Author Response

Thank you for your invaluable suggestions on the article entitled “ Ultrasonographic Diagnosis of Fetal Hypospadias” (Diagnostics -1618800) .

Below are the revision made according to the referee’s opinion.

• There are several doppler images of the urinary stream in hypospadias but no images of normal flow pattern to compare with. I think it would be helpful to have normal images to compare with.

Response:

I have added an image of normal male fetus with jet of urinary stream to Figure 3 designated “c”

• All postnatal images are really poor quality. Please resubmit better ones.

Response:

All postnatal images have been reload with better quality

• Also, majority of images do not have arrows pointing to the abnormal finding even thoug figure legends state otherwise. Arrows missing in Figure 2, 3, 5, 6 and 7.

Response:

All arrows have been clearly marked in the new version

• General comments: Do the the authors have some recommendations for antenatal screening regarding hypospadias?

Response:

Most antenatal screening of fetal hypospadias could be carry out after 20 weeks of gestational age with color Doppler showing the fanning of urinary stream as a confirmatory tool in fetus with short and blunt penis . Additional searching for other anomalies and karyotyping should be consider for further evaluation. This paragraph has been added in the discussion section.

Reviewer 2 Report

Dear Sir,

I have read carefully the manuscript. It represents a short series of prenatally diagnosed hypospadias cases. In my opinion the article worth to be, publish with some modifications:

• the ultrasound images are not blinded - patient name can be seen on several images
• the quality of the postnatal pictures is poor - the images are difficult to see
• even though it is mentioned in discussion that hypospadias can be associated with other congenital anomalies nothing is mentioned about the prenatal genetic evaluation of the cases
• the references list needs to be improved; there are some other reports of antenatal diagnosis of hypospadias that are not cited.

I encourage the authors to resubmit the article taking into account these recommendations.

Author Response

Thank you for your invaluable suggestions on the article entitled “ Ultrasonographic Diagnosis of Fetal Hypospadias” (Diagnostics -1618800) .

Below are the revision made according to the referee’s opinion.

• the ultrasound images are not blinded - patient name can be seen on several images

Response:

All ultrasound images have been blinded with patient’s name deleted

• the quality of the postnatal pictures is poor - the images are difficult to see

Response:

All the postnatal pictures have been reload with better quality

• even though it is mentioned in discussion that hypospadias can be associated with other congenital anomalies nothing is mentioned about the prenatal genetic evaluation of the cases

Response:

Regarding prenatal genetic screening The following has been added

Case #1 A 32 year old female G3P1A1 with normal antenatal screening and normal Quad test

Case #2 A 25 year old female G1P0 with normal antenatal examination and NIPS

Case #3 A 29 year old female G4P2A1 pregnant at 26+2 weeks with normal antenatal examination and Quad test

Case #4 .Normal karyotyping with 46XY was found

• the references list needs to be improved; there are some other reports of antenatal diagnosis of hypospadias that are not cited.

Response:

3 other references have been added and designated as 6, 7, 8

Reviewer 3 Report

Hypospadias is one of the most common malformations of the genitourinary system in boys. It is the second most common urinary congenital anomalies secondary to undescended testis. The Case report (diagnostics-1618800) titled „Ultrasonographic Diagnosis of Fetal Hypospadias” deals with the diagnosis of hypospadias in various stages of prenatal life. Much is known about hypospadias, but prenatal diagnosis still requires fetal anatomy study.

The urine flow observed in the presented study can facilitate the diagnosis of hypophagia and determine the degree of changes. It is an interesting diagnostic tool.

I recommend this work for the further publication process.

Author Response

Thank you for your invaluable suggestions on the article entitled “ Ultrasonographic Diagnosis of Fetal Hypospadias” (Diagnostics -1618800) .

Below are the revision made according to the referee’s opinion.

• Hypospadias is one of the most common malformations of the genitourinary system in boys. It is the second most common urinary congenital anomalies secondary to undescended testis. The Case report (diagnostics-1618800) titled „Ultrasonographic Diagnosis of Fetal Hypospadias” deals with the diagnosis of hypospadias in various stages of prenatal life. Much is known about hypospadias, but prenatal diagnosis still requires fetal anatomy study.

The urine flow observed in the presented study can facilitate the diagnosis of hypophagia and determine the degree of changes. It is an interesting diagnostic tool.

I recommend this work for the further publication process.

Response:

Thank you for your kindly recommendation for publishing this article

Reviewer 4 Report

Two issues:

1. the congenital defect when isolated is likely a malformation / when present with other anomalies there is a need to describe them as malformation; disruption; deformation; or dysplasia to better understand the pathology pathway
2. an additional figure is required for 'the normal penile shaft ' comment. 

Author Response

Thank you for your invaluable suggestions on the article entitled “ Ultrasonographic Diagnosis of Fetal Hypospadias” ( Diagnostics -1618800) .

Below are the revision made according to the referee’s opinion.

• the congenital defect when isolated is likely a malformation / when present with other anomalies there is a need to describe them as malformation; disruption; deformation; or dysplasia to better understand the pathology pathway

Response:

Isolated congenital defect is most likely to be a single organ’s malformation while associated with other anomalies a different pathway either as malformation; disruption; deformation or dysplasia or even a syndrome should be mentioned.

• an additional figure is required for 'the normal penile shaft ' comment.

Response:

I have added a normal penile shaft designated as Fig 1b

Round 2

Reviewer 1 Report

Thanks you for revising the manuscript. I am pleased with the changes and have no further queries.