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Circumcised Hypospadias

March 29, 2017

UroToday - In a recent article, Dr. Rafael V. Pieretti, et al., evaluated the circumcised hypospadias patient. His group retrospectively reviewed 48 consecutive boys who had been diagnosed with hypospadias and had also been previously circumcised. In all the cases the hypospadias was corrected with either urethral plate tubularization or MAGPI type of procedure. They did not utilize any skin flaps. All the patients were followed for at least eight months.

Their findings were that prior circumcision did not negatively affect the results of their hypospadias repair. They felt that the use of a Snodgrass type of procedure has virtually eliminated the need for skin flaps for the these repairs.

It would be interesting to see a video of their reconstructive procedure since typically skin flaps are utilized because of the paucity of ventral skin. At my institution, we have to follow our patients for quite a long time. They state that they follow their patients for at least eight months, and in my opinion this is not long enough at all. We are starting to see older boys, and especially young men at the age of 17 or 18, who are having difficulty with their hypospadias repairs. The tubes might become static in nature as time elapses and may not perform as well as we would like - or at least not with the same success rate that we see early on through the potty training years. We need to be cognitive of this dilemma. Maintaining a database would be very helpful so we can contact these patients throughout their childhood and adolescence to ascertain if there is any difficulty. Especially when these patients become adults and they start moving around, maintaining contact will be of extreme importance.

Pieretti RV, Pieretti A, Pieretti-Vanmarcke R
Pediatr Surg Int. 2008 Oct 11. (Epub ahead of print)

UroToday Medical Editor Pasquale Casale, MD

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