Proximal Hypospadias: Additional Evaluation Before Surgery

This combination meaningfully increases the likelihood of an underlying difference of sex development, and international guidelines recognize it as a reason for evaluation before surgery.

• The goal isn't to attach a diagnostic label; it's to clarify the hormonal and genetic picture so that the surgical plan, timing, and long-term follow-up are set up correctly. In most cases, no additional problem is found, and the planned repair goes ahead as scheduled.

• A detailed physical examination: the position of the testes, the structure of the scrotum, and penis size measured against age norms.
• Karyotype (chromosome analysis).
• A hormone profile, with stimulation tests when needed.
• Pelvic and abdominal ultrasound, with further imaging if needed.
• Evaluation of the kidneys and urinary system.

Evaluation comes first, surgery second. This step isn't about delaying the operation — it's about making sure the right operation is performed. The evaluation is usually completed within a few weeks, and the preferred 6-to-18-month window for repair can generally still be kept.