Guideline sources The following summarized guidelines for the evaluation and management of hypospadias are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the Canadian Urological Association (CUA 2017), and the American Urological Association (AUA 2014). 1 2 3 Guidelines 1. Diagnostic investigations Evaluation for disorders of sex development: As per EAU 2022 guidelines, differentiate isolated hypospadias from disorders of sex development at birth which are mostly associated with cryptorchidism or micropenis. A As per CUA 2017 guidelines, obtain karyotype testing in patients with at least one undescended testicle and proximal hypospadias, especially in the setting of non-palpable gonads. B As per AUA 2014 guidelines, assess for the possibility of a disorder of sex development in patients with cryptorchidism and severe hypospadias. B 2. Perioperative care https://web.pathway.md/diseases/reco5V5OeFHwoQ735 1/3 6/24/23, 12:47 PM Hypospadias Pathway Preoperative hormonal therapy: consider offering preoperative androgen stimulation therapy to increase penile length and glans circumference C in pediatric patients with proximal hypospadias and a small appearing penis, reduced glans circumference or reduced urethral plate. C Perioperative antibiotics: Consider administering intraoperative antibiotic prophylaxis during hypospadias repair. C Avoid administering postoperative antibiotic prophylaxis after hypospadias repair. D 3. Surgical interventions Surgical repair (timing): Consider performing primary hypospadias repair at age of 6-18/24 months. C Recognize that age at surgery is not a risk factor for complications in prepubertal patients undergoing tubularized incised plate urethroplasty repair. B Surgical repair (penile curvature correction and urethroplasty): correct the penile curvature and form a neo-urethra of adequate size with an opening on the glans with proper skin coverage of the penile shaft to achieve an overall acceptable functional and cosmetic outcome. B Show 14 more Surgical repair (dressing): consider placing a circular dressing with slight compression. C 4. Patient education General counseling: counsel caregivers on functional indications for surgery, esthetically feasible operative procedures (psychological, cosmetic indications) and possible complications. A 5. Follow-up and surveillance Postoperative follow-up: obtain long-term follow-up to detect urethral stricture, voiding dysfunctions and recurrent penile curvature, ejaculation disorder, and to evaluate patient's satisfaction. A Show 3 more References 1. Kolon TF, Herndon CD, Baker LA et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014 Aug;192 2 337 45. Open 2. Lisette A 't Hoen, Guy Bogaert, Christian Radmayr et al. EAU guidelines on Paediatric Urology. EAU. 2022 Mar. Open https://web.pathway.md/diseases/reco5V5OeFHwoQ735 2/3 6/24/23, 12:47 PM Hypospadias Pathway 3. Luis H Braga, Armando J Lorenzo, Rodrigo L P Romao. Canadian Urological Association-Pediatric Urologists of Canada CUA PUC guideline for the diagnosis, management, and followup of cryptorchidism. Can Urol Assoc J. 2017 Jul;11 7 E251 E260. Open https://web.pathway.md/diseases/reco5V5OeFHwoQ735 3/3