The finding at birth of a congenital anomaly of the penis inevitably generates both anxiety and concern among the Parents.
Hypospadias truly represent one of the most frequent male genital malformation. It is important though to remember that, in the fetal life during the genital development, interferences may happen which produce a spectrum of different malformations.
In some cases only the prepuce or the penile skin are involved (ie prepucial variants, mega-prepuce, concealed penis) without any implication on the urethral channel development and with marginal and milder clinical implications. In some other cases there is a variable arrest in the urethral channel development (hypospadias) and its opening will not occur at the apical glanular level but in a variable position between the perineo-scrotal region (more severe/proximal forms), the penile shaft (mid forms) and the glanular region (mild or distal forms).
Nearly 70% of all hypospadias are distal forms with normal corpora cavernosa and normal testis therefore without any future implication on the subsequent sexual life and the fertility potential.
Ample discussion still exists on the surgical indications and the real need for a correction (functional versus purely cosmetic reasons) and the correct age for the repair (in order to limit the impact and the psychological reaction of the child during the hospital admission). Conversely there is an overall consensus in recognizing this micro-surgical reconstructive surgery as super-specialistic and to be concentrated only in highly selected and dedicated Centers.
The surgical correction of an hypospadias can be performed with many different reconstructive techniques (as a single stage or multi-staged for the more proximal forms) and the choice and the final decision should always be based on a wise and competent intra-operative evaluation.