Paediatric general surgery (question 20): a free FRCS (Gen Surg) Section 1 question

A dorsal hooded foreskin with a ventrally placed meatus is hypospadias, often with chordee. Repair is carried out by a paediatric urologist, usually between 6 and 18 months, and the preputial skin is the tissue used to reconstruct the urethra or to cover the repair, so circumcision by any technique is contraindicated until the surgeon who will do the repair has decided the foreskin is not needed. The family should be referred and told that a circumcised appearance can usually be achieved at the repair. Distal position of the meatus does not change this. Isolated distal hypospadias carries no increased risk of urinary infection or upper tract anomaly, so neither prophylactic circumcision nor routine renal ultrasound is indicated. Reference: Bailey & Love's Short Practice of Surgery 28e; Royal College of Surgeons of England, Commissioning guide: foreskin conditions (2013).