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Hypospadias

Key sources
The following summarized guidelines for the evaluation and management of hypospadias are prepared by our editorial team based on guidelines from the European Association of Urology (EAU/ESPU 2023), the Canadian Urological Association (CUA 2017), and the American Urological Association (AUA 2014).
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Guidelines

1.Diagnostic investigations

Evaluation for disorders of sex development: as per EAU 2023 guidelines, differentiate isolated hypospadias from disorders of sex development at birth which are mostly associated with cryptorchidism or micropenis.
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2.Perioperative care

Preoperative hormonal therapy: consider offering preoperative androgen stimulation therapy to increase penile length and glans circumference
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in pediatric patients with proximal hypospadias and a small appearing penis, reduced glans circumference or reduced urethral plate.
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  • Perioperative antibiotics

3.Surgical interventions

Surgical repair, timing
Consider performing primary hypospadias repair at age of 6-18/24 months.
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Recognize that age at surgery is not a risk factor for complications in prepubertal patients undergoing tubularized incised plate urethroplasty repair.
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  • Surgical repair (penile curvature correction and urethroplasty)

  • Surgical repair (dressing)

4.Patient education

General counseling: counsel caregivers on functional indications for surgery, esthetically feasible operative procedures (psychological, cosmetic indications) and possible complications.
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5.Follow-up and surveillance

Postoperative follow-up: obtain long-term follow-up to detect urethral stricture, voiding dysfunctions and recurrent penile curvature, ejaculation disorder, and to evaluate patient's satisfaction.
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