Why Circumcision Should Wait When Hypospadias Is Suspected

Several of the techniques used in hypospadias repair rely on flaps or grafts prepared from the foreskin — the onlay island flap, graft-supported plate widening, and a protective interposition layer chief among them.

• This tissue is thin, flexible and well-vascularized, and it tolerates a moist environment well. Once it is removed there is no equivalent tissue to replace it with; the alternative, oral mucosa, means a separate surgical site and an additional procedure.

In every baby scheduled for circumcision, the underside of the penis should be examined in good light beforehand. The foreskin should be gently retracted so the position of the urinary opening can be seen directly.

• This check matters in particular because in the subtype called megameatus with intact prepuce, the foreskin looks completely normal, and the condition is often only discovered during the circumcision itself.

During the hypospadias repair itself. Circumcision is completed as the skin is closed at the end of the operation — no separate procedure is needed.

• If the family prefers, the foreskin can instead be preserved and reconstructed. This choice should be discussed before surgery.