Commentary to “A standardized classification of hypospadias”

Abstract

It has been accepted, by the majority of hypospadias surgeons, for a long time that a classification of hypospadias based simply on the position of the external urethral meatus was both inaccurate and misleading. Professor P.D.E. Mouriquand has argued that the division of the corpus spongiosus is a more accurate criterion of the severity of hypospadias and the degree of hypoplasia of the ventral penile tissue. This paper supports that hypothesis with some excellent and well presented data. It describes how the division of the corpus spongiosus can be assessed preoperatively and, in addition to that, it introduces a novel assessment that can be performed per-operatively, relating the division of the spongiosus to the upper margin of the pubic symphysis. This will provide a more rigid classification system enabling a more accurate comparison of the outcomes of different operative techniques. At international meetings many surgeons still state that they will correct distal hypospadias but not the more severe proximal forms! This paper will be a useful tool in putting an end to this unacceptable practice. It convincingly shows that the position of the external meatus is not a true reflection of the severity of hypospadias, and on many occasions the actual severity can only be accurately assessed perioperatively. No surgeon should undertake any hypospadias repair unless they can correct all degrees of severity.