An 8-month-old boy is brought for evaluation of glanular hypospadias with mild chordee. His parents ask whether he should be circumcised at the same visit. What is the appropriate advice?

• A Circumcision should be performed now, as the foreskin serves no purpose
• B Circumcision should be deferred because the preputial skin is required for the corrective repair ✓
• C Circumcision must be done before six months of age or the repair will fail
• D Hypospadias repairs require the child to be circumcised at least one year before surgery

Explanation

In hypospadias the foreskin is characteristically deficient ventrally and hooded dorsally, and this redundant dorsal preputial skin is precisely the tissue used to reconstruct the neourethra and cover the ventral shaft during repair. Circumcising the child would remove the flap material and complicate reconstruction. Repair is undertaken electively between about 6 and 18 months of age, well before the child develops body awareness and memory of the procedure.

Reference: Pediatric Surgery (Coran), 8th ed.

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Written and medically reviewed by the StethoPrep medical team.