An infant boy has distal penile hypospadias with chordee scheduled for surgical correction. Which instruction regarding the foreskin must be given to the parents before surgery?
- A The foreskin should be preserved as it may be used in the repair ✓
- B Circumcision should be performed at birth to keep the area clean
- C Daily forcible retraction of the foreskin is needed to prevent adhesions
- D Topical testosterone should be avoided entirely in these children
Correct answer: A. The foreskin should be preserved as it may be used in the repair
Explanation
Hypospadias repair commonly uses a flap or graft of inner preputial skin to reconstruct the neo-urethra, so circumcision must not be performed before correction and the child should be referred intact. Ideal age for single stage repair is around 6 to 18 months. Forcible retraction risks scarring and trauma. Preoperative topical testosterone can be used to enlarge genital skin in small phalluses and is not contraindicated. Chordee correction is combined with urethroplasty in the same sitting when significant.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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