[Management of hypospadias]

Hypospadias are diagnosed at birth. Counseling of the parents should be performed in detail. Isolated hypospadias has to be differentiated from disorders of sexual development which are mostly associated with cryptorchidism and micropenis. The operation is timed around the first birthday. Preoperative hormonal treatment should be reserved for infants with a small glans penis or for repeat surgery. The most popular method in distal hypospadias repair is preservation of the urethral plate and tubularization with or without midline incision. In proximal cases with severe curvature a two-stage procedure may be preferable. Dripping-stent urinary drainage into a double diaper is the best method in infants. The complication rate after primary distal repair is reported in the literature to be less than 10% and after staged procedures in proximal hypospadias over 25%.