Hypospadias: Management and outcome
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
Hypospadias is a congenital anomaly of the male urethra that results in abnormal ventral placement of the urethral opening. The location of the displaced urethral meatus may range anywhere within the glans, the shaft of penis, the scrotum, or perineum (picture 1).
The management and outcome of hypospadias will be reviewed here. The pathogenesis, diagnosis, and evaluation of hypospadias are discussed separately. (See "Hypospadias: Pathogenesis, diagnosis, and evaluation".)
Surgical correction for hypospadias is an elective procedure. The clinician's role is to provide information regarding the balance of potential benefits and complications to the family. For infants with mild defects (forme fruste or incomplete or partial presence of hypospadias) with a normally functional penis in respect to voiding and future sexual function, surgical correction is not warranted. However, correction may be entertained for cosmetic reasons based on family preference, as some families may want to correct any asymmetric foreskin defect for religious (circumcision) or social reasons.
Urologic referral — The need for urological referral is based on the severity of the hypospadias and family preference (table 1).
Urologic referral and correction are reserved for those patients in whom there is a potential functional issue including:
- Dodds PR, Batter SJ, Shield DE, et al. Adaptation of adults to uncorrected hypospadias. Urology 2008; 71:682.
- Chalmers D, Wiedel CA, Siparsky GL, et al. Discovery of hypospadias during newborn circumcision should not preclude completion of the procedure. J Pediatr 2014; 164:1171.
- Shukla AR, Patel RP, Canning DA. Hypospadias. Urol Clin North Am 2004; 31:445.
- Snodgrass WT, Koyle MA, Baskin LS, Caldamone AA. Foreskin preservation in penile surgery. J Urol 2006; 176:711.
- Timing of elective surgery on the genitalia of male children with particular reference to the risks, benefits, and psychological effects of surgery and anesthesia. American Academy of Pediatrics. Pediatrics 1996; 97:590.
- Cheng EY, Vemulapalli SN, Kropp BP, et al. Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias? J Urol 2002; 168:1723.
- Rushton HG, Belman AB. The split prepuce in situ onlay hypospadias repair. J Urol 1998; 160:1134.
- Baskin LS, Duckett JW, Ueoka K, et al. Changing concepts of hypospadias curvature lead to more onlay island flap procedures. J Urol 1994; 151:191.
- Baskin LS, Ebbers MB. Hypospadias: anatomy, etiology, and technique. J Pediatr Surg 2006; 41:463.
- Mingin G, Baskin LS. Management of chordee in children and young adults. Urol Clin North Am 2002; 29:277.
- McNamara ER, Schaeffer AJ, Logvinenko T, et al. Management of Proximal Hypospadias with 2-Stage Repair: 20-Year Experience. J Urol 2015; 194:1080.
- Cerasaro TS, Brock WA, Kaplan GW. Upper urinary tract anomalies associated with congenital hypospadias: is screening necessary? J Urol 1986; 135:537.
- Davenport M, MacKinnon AE. The value of ultrasound screening of the upper urinary tract in hypospadias. Br J Urol 1988; 62:595.
- Prat D, Natasha A, Polak A, et al. Surgical outcome of different types of primary hypospadias repair during three decades in a single center. Urology 2012; 79:1350.
- Conte F, Grumbach M. Pathogenisis, classification, diagnosis and treatment of anomalies of sex. In: Endocrinology, DeGroot LJ (Ed), Saunders, Philadelphia 1995.
- Akbiyik F, Tiryaki T, Senel E, et al. Clinical experience in hypospadias: results of tubularized incised plate in 496 patients. Urology 2009; 73:1255.
- Schneuer FJ, Holland AJ, Pereira G, et al. Prevalence, repairs and complications of hypospadias: an Australian population-based study. Arch Dis Child 2015; 100:1038.
- Lee OT, Durbin-Johnson B, Kurzrock EA. Predictors of secondary surgery after hypospadias repair: a population based analysis of 5,000 patients. J Urol 2013; 190:251.
- Wright I, Cole E, Farrokhyar F, et al. Effect of preoperative hormonal stimulation on postoperative complication rates after proximal hypospadias repair: a systematic review. J Urol 2013; 190:652.
- Gearhart JP, Jeffs RD. The use of parenteral testosterone therapy in genital reconstructive surgery. J Urol 1987; 138:1077.
- Spinoit AF, Poelaert F, Groen LA, et al. Hypospadias repair at a tertiary care center: long-term followup is mandatory to determine the real complication rate. J Urol 2013; 189:2276.
- Andersson M, Doroszkiewicz M, Arfwidsson C, et al. Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood. J Urol 2015; 194:1407.
- Schönbucher VB, Landolt MA, Gobet R, Weber DM. Psychosexual development of children and adolescents with hypospadias. J Sex Med 2008; 5:1365.
- Urologic referral
- Avoidance of circumcision
- - Choice of surgical procedure
- Anesthesia risks
- POSTOPERATIVE MANAGEMENT
- Postoperative care
- Follow-up care
- HORMONAL THERAPY NOT BENEFICIAL
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS