Repair of Distal Hypospadias: Cosmetic or Reconstructive?

Abstract

Objective: Hypospadias is one of the most common congenital anomalies of male genitalia and is usually repaired in the first 2 years of life. Regarding distal forms of hypospadias, however, controversies surrounding the need for surgical repair may lead to delayed referral secondary to symptoms. This article reviews the authors’ experience in boys who presented with symptoms secondary to an untreated distal hypospadias. Materials and methods: The authors reviewed their prospectively maintained database and included all children who were secondarily referred because of symptoms due to untreated distal hypospadias in the last 5 years. The data were reviewed and analysed. Results: Seventeen patients were identified. The median age at referral was 118 months. Symptoms at presentation included poor stream, straining during voiding, incontinence, and unhappiness related to cosmesis. Surgical correction included meatoplasty or tubularised incised plate urethroplasty. The choice between foreskin reconstruction or circumcision was based on parental preference. Conclusion: The authors have presented a cohort of children with untreated distal hypospadias associated with functional and cosmetic problems. Both could be underestimated at birth, leading to problems in late childhood. Viewing repair of distal hypospadias as a purely cosmetic surgery is to disregard the nature of the anomaly and its associated implications.