Editorial Comment

Abstract

Surgical techniques develop and become more widely adopted when they offer some tangible advantage. A particular method that is effective, easy to learn, and execute will typically become more popular. Other methods may still exist because of specific circumstances where they have some advantage or because of some local or regional issue. In the matter of distal hypospadias, it is known that in the hands of expert hypospadiologists, the use of a stenting urethral catheter may not be absolutely necessary. This study randomized patients among three experienced surgeons using the tubularized incised plate method and found that there was no difference between those who were stented and those who were not. Hypospadias procedures historically have been hard to assess because of the many confounding factors that needed to be controlled. These include variations among the patients, surgeon experience, length of follow-up, and the method used to assess long-term success. Surgical procedures are also notoriously hard to randomize with patients and families often wanting to take an active role in the choice. The findings of the authors based on a randomized approach makes a good case for avoiding stents in this particular situation but notably the authors laid out a specific set of physical parameters regarding transverse glans diameter and urethral plate width. The fistula rate overall at 5% seems consistent with what has been reported in the literature. As the authors noted, the long-term results functionally are hard to know due to the shorter follow-up and the small fraction of all patients that had a postprocedure uroflow. It is hoped that other studies will build upon this type of systematic effort and help form the basis for other rigorous research into hypospadias treatment.