Proximal hypospadias: we aren’t always keeping our promises

Abstract

Hypospadias surgery is a humbling art form. The evolution of surgical techniques has made distal hypospadias outcomes favorable, but recent publications suggest that our complication rates for proximal hypospadias are much higher than previously reported. To explain these shortcomings, we examine the literature and focus on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow up. The variability in surgical technique and the fact that the literature abounds with small case series from single institutions also limits our ability to compare outcomes. We believe that the use of standardized and scored phenotype assessments from diagnosis through the extended postoperative period will allow for improved scientific assessment of outcomes. This will facilitate multi-institution collaboration and tabulation of outcomes, allowing rapid data accumulation and assessment for this rare disorder. As surgeons, we must follow boys through puberty into adulthood and must honestly report our results in order to advance our surgical approach to this complicated problem.

Proximal hypospadias treated with a transverse preputial island tube: long‐term functional, sexual, and cosmetic outcomes

“…Although the overall complication rate of patients with proximal hypospadias is high, it is similar to the long-term rates (range 32-68%) reported in a review on proximal hypospadias [13]. Long-term studies always tend to be on the higher end of complication rates, due to better patient compliance with complications, and a longer lead time.…”

“…The goals of hypospadias repair are a laminar urinary stream, normal sexual function with a straight penis in erection, and a normal penile appearance. To effectively assess the outcomes of a repair technique, long‐term evaluation is mandatory . We hypothesised that the long‐term outcomes for patients with proximal hypospadias who underwent TPIT would be less satisfactory compared to long‐term outcomes in patients operated for distal hypospadias.…”

Results of two-stage transverse preputial island flap urethroplasty for proximal hypospadias with chordee that mandate division of the urethral plate

“…The goals of repair in proximal hypospadias include; straight penis, adequate caliber of the neourethra, slit-like meatus with a well-formed glans, and normal voiding with adequate stream and minimal postoperative complications [ 3 , 16 ]. There is a universal trend towards two-stage repair for repair of proximal hypospadias [ 5 , 6 , 7 ], however; the choice between flaps and grafts depends on institution preference [ 17 ].…”

Dorsal midline incision: A versatile technique for correction of meatal stenosis during hypospadias repair

“…9,12 The longer the tube, the greater the resistance is, thus requiring more pressure to push out the urine, which in turn leads to fistula and diverticula formation. 13 Based on the above facts, we think that meatal stenosis is best treated by a procedure which does not cause a proximal shift of the meatus. Such a technique thereby decreases the possibility of UCF.…”