Table of contents



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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Diagnostic investigations

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

Preoperative hormonal therapy: as per EAU/ESPU 2023 guidelines, consider offering preoperative androgen stimulation therapy to increase penile length and glans circumference
in pediatric patients with proximal hypospadias and a small appearing penis, reduced glans circumference or reduced urethral plate.

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  • Perioperative antibiotics

Surgical interventions

Surgical repair, timing
As per EAU/ESPU 2023 guidelines:
Consider performing primary hypospadias repair at age of 6-18/24 months.
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)

Patient education

General counseling: as per EAU/ESPU 2023 guidelines, counsel caregivers on functional indications for surgery, esthetically feasible operative procedures (psychological, cosmetic indications) and possible complications.

Follow-up and surveillance

Postoperative follow-up: as per EAU/ESPU 2023 guidelines, 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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