Proximal Hypospadias

The channel that needs to be reconstructed is long. That length increases both the technical difficulty and the number of things that need to be monitored after surgery.

• Pronounced curvature frequently accompanies this group. While the curvature is being corrected, unhealthy tissue on the underside is removed, leaving a gap that needs to be filled with added tissue. Because that added tissue can't be turned into a tube until it has established its own blood supply, the repair is often split into two stages.

• The degree of curvature is measured with an artificial erection test, repeated after the skin is released.
• The width, flexibility, and blood supply of the urethral plate are assessed directly.
• The testes and scrotal structure are examined for undescended testes.
• Kidney and urinary system ultrasound comes up more often in this group.

If the proximal position is accompanied by an undescended testis, a scrotum divided into two, or a noticeably small penis, a separate evaluation is needed before surgery. This is a step that shouldn't be skipped.

• Single-stage repair in selected cases — when the plate can be preserved and the curvature is minimal.
• Staged repair — when the plate can't be preserved or the curvature is pronounced. Two operations roughly 6 months apart.
• Pre-operative testosterone treatment — can ease the repair by increasing tissue size.