Prior circumcision does not complicate repair of hypospadias with an intact prepuce

Hypospadias concealed by an intact prepuce is a concern to practitioners performing newborn circumcision, especially given reports that foreskin removal may complicate urethroplasty. However, distal hypospadias repair today less often relies on skin flaps, and some patients may have circumcision interrupted for suspected urethral anomalies when none is present. We evaluated outcomes in consecutive males with hypospadias and an intact prepuce to compare results of urethroplasty in those with vs without prior circumcision.

A retrospective review of consecutive patients with hypospadias and an intact prepuce was performed. Patients circumcised before the urethral defect was recognized comprised group 1, while those presenting without circumcision comprised group 2. In all cases urethroplasty was accomplished by urethral plate tubularization without skin flaps, with coverage of the neourethra by a dartos flap.

A total of 63 patients with hypospadias and an intact prepuce were operated on by one of us (WTS). Followup was at least 6 weeks for 36 of these patients, who comprised the study. There were no differences in age or followup among the 26 patients in group 1 compared to the 10 patients in group 2. The only complication was a fistula detected 4 years after surgery in a patient in group 1.

Prior circumcision did not complicate subsequent hypospadias repair in males whose urethral anomaly was concealed by an intact prepuce. While circumcision should not be performed in newborns with obvious penile defects, it can be done in those with a normal foreskin without concern for the occasional discovery of hypospadias with an intact prepuce.