Hypospadias Repair Research Articles

The long-term consequences of the hypospadias salvage repair issue

PurposeTo present the long-term results of redo-hypospadias at our tertiary referral center following a failed prior repair.MethodsOne hundred sixty-four individuals with a history of unsuccessful repairs qualified for our retrospective cohort study. Our inclusion criteria were as follows: pre-operative data that was accessible, redo-hypospadias that was successfully repaired, and at least three years of follow-up at the last hospital visit.ResultsThe mean patient age was 91.3 ± 21.1 months. The mean follow-up after successful repair was 41.3 ± 3.1 months. Ninety-two (group A) had one prior repair, and 72 (group B) had 2 or 3 repairs. Group A underwent six primary techniques: 32 underwent Onlay Island Flap (OIF), 10 underwent Mathieu, 12 underwent Tubularized Incised Plate Urethroplasty (TIPU), 8 underwent Urethral Mobilization (UM), and 34 underwent Buccal Mucosal Graft (BMG) { dorsal inlay Graft Urethroplasty (DIGU) in 4 and staged BMG in 30 patients}. In group B, four procedures were used: TIPU in 4, UM in 6, and BMG in 62 (staged BMG in 50 cases and DIGU in 12).ConclusionsThe selected type of repair will depend on many factors, like residual healthy local skin and expertise. Safe techniques for repair of redo hypospadias after its 1st failure include TIPU, Mathieu, UM, OIF, and DIGU for distal varieties. After 2nd or 3rd repair DIGU, UM, and TIPU can be performed in distal types, while staged BMG can be applied for proximal ones.

Surgical and functional outcomes of Dorsal Inlay Graft urethroplasty in revision vs primary hypospadias repair in the pediatric age

Over the years, Dorsal Inlay Graft (DIG) urethroplasty has gained worldwide acceptance for primary hypospadias repair. However, its safety and effectiveness for revision surgery are yet to be proven. The aim of the study is to assess and compare complication rates and functional outcomes of DIG surgery in revision versus primary hypospadias repair. We carried out a retrospective analysis of data collected from 53 consecutive DIG urethroplasties performed by a single surgeon at our institution. Patients were stratified in two groups - primary repair and redo-urethroplasty. For each group, we recorded standard pre-operative characteristics, surgical technicalities, complication rates and uroflowmetry parameters. Out of 53 DIG urethroplasties, 21 (39.6%) where primary and 32 (60.4%) were re-do. As expected, the two groups differed for median age at surgery: 20 months for primary and 68.5 months for revision surgery (p<0.001). Additionally, all 21 (100%) primary interventions were performed with a preputial graft, whereas among revision DIG urethroplasties only 2 (6.3%) where preputial and 30 (93.8%) were buccal (p<0.001). Catheterization time (7 vs 8 days, p=0.155) and postoperative complication rates (14.3% vs 9.4%, p=0.581) were comparable between the primary and revision surgery group, respectively (all p>.05). Forty-two of the 53 patients underwent uroflowmetry during follow-up. Of these, 19 (63%) patients presented with abnormal uroflowmetry and 11 (37%) had equivocal parameters with no difference between the two groups. Dorsal Inlay Graft urethroplasty has long been known to be safe and effective for primary hypospadias repair. On the other hand, data on dorsal inlay graft urethroplasty as a salvage surgery after primary hypospadias repair failure is scarce. Surprisingly, according to our findings, surgical outcomes and complication rates are comparable between primary and revision hypospadias cases. Additionally, our results in the redo group are absolutely encouraging if compared to those reported in the literature for the same subset of patients. According to our findings, DIG urethroplasty is a safe and effective option to treat revision hypospadias repair.

Teaching hypospadias repair by utilising a novel 3D-printed silicon model: An initial assessment using structured trainee and trainer feedback

Simulated paediatric surgical training is inherently advantageous and flourishing. Moreover, several working conditions resulted in reduced training hours, index and subspecialty cases encountered, and the COVID-19 pandemic affected elective surgery backlogs, hence training opportunities. Hypospadias repair is technically-demanding and requires a spectrum of dissective and reconstructive skills. We therefore aimed to test a 3D-printed silicon model for hypospadias repair, in the context of hands-on surgical training. Twenty-Seven trainees, under the supervision of 15 instructors, completed the activity. They were given a seminar to show the relevant anatomy, and 8 key steps of the exercise: (1)-degloving; (2)-urethral plate marking; (3)-incision; (4)-tubularisation; (5)-glansplasty/glanuloplasty; (6)-dartos layer preparation; (7)-preputioplasty and (8)-skin closure. Each trainee completed a structured feedback assessment. An on-site trainer supervised and evaluated each exercise. Trainees and trainers rated the model through the above steps from unsatisfactory-(1/5) to excellent-(5/5), presented herein via cross-sectional analysis. Eleven-(40.7%) trainees were in years:1-3 of specialist training, 10-(37%) were in years:4-6, and 6-(22.2%) were beyond year-6. Two-(7.4%) trainees had nil-hypospadias experience, 16-(59.2%) previously assisted in procedures or performed steps, 5-(18.5%) performed whole procedures supervised and 4-(14.8%) independently. Twenty-(74%) trainees and 15-(100%) instructors judged the model to resemble the anomaly. Seventeen-(63%) trainees and 13-(86.6%) instructors rated the material needle-penetrability ≥3/5, compared to human tissue. Sixteen-(59%) trainees and 13-(86.6%) instructors rated the material suture holding ≥3/5. Eleven-(73.3%) trainees and 13-(86.6%) instructors rated sutures' evenness and edge coaptability ≥3/5. Hypospadias is an index operation, which requires precision skills. Simulated training in Paediatric Surgery and Urology is gaining importance. 3D-printed models are gaining a key role in simulated training. The study presents a novel 3D-printed high-fidelity silicon-based hypospadias model designed for hands-on training. A structured pathway to divide a standard hypospadias repair into key steps is displayed to ensure skill acquisition and stabilisation. This 3D-printed silicon-based hypospadias model is proven useful for hands-on training. The fidelity can still improve, especially regarding suture holding of the material. LEVEL III.

The median effective concentration of ropivacaine for ultrasound-guided caudal block in children: a dose-finding study.

To determine the 50% minimum effective concentration (MEC50) and the 95% effective concentration (MEC95) of ropivacaine for ultrasound-guided caudal block during hypospadias repair surgery of pediatric patients. Children were enrolled with the American Society of Anesthesiologists (ASA) physical status I-II undergoing elective hypospadias repair surgery. Children were grouped into two age groups: toddlerhood (1-3years old) and preschool (3-6years old). We measured The MEC50 using Dixon's up-and-down method. Thefirstchildren received the caudal block with 1.0mL/kg of 0.15% ropivacaine. We determined each subsequent patient's concentration based on the previous patient's response and adjusted the concentration in intervals of 0.015%. Meanwhile, the probit regression analysis obtains 95% effective concentration (MEC95). In addition, we recorded the general condition, adverse events, and postoperative pain of each child. 46 children undergoing elective hypospadias repair surgery were included in this study, 22 in the toddlerhood group and 24 in the preschool group. Of the total number of patients, the caudal block was successful in 25 (54%) and failed in 21 (46%). The MEC50 of 1ml/kg ropivacaine was 0.102% (95% CI 0.099%, 0.138%) in the toddlerhood group and 0.129% (95% CI 0.124%, 0.138%) in the preschool group. The MEC95 of 1ml/kg ropivacaine was 0.148% (95% CI 0.131%, 0.149%) in the toddlerhood group and 0.162% (95% CI 0.134%, 0.164%) in the preschool group. Our results showed that ropivacaine concentration was statistically different between preschool children and toddlers (P < 0.001). None of the adverse events occurred. This study showed that children in the preschool group required higher concentrations of ropivacaine than children in the toddler group during ultrasound-guided sacral block combined with non-intubated general anesthesia. At the same time, this method of anesthesia is safe and effective for children undergoing surgery for hypospadias.

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures

BackgroundPolyglactin (PG) and polydioxanone (PDS) sutures are extensively used based on the surgeon’s preference. The development of post-reconstruction urethrocutaneous fistula (UCF) is variably attributed to the choice of suture material...

Hypospadias Repair: Outcome and Objective Evaluation with Hypospadias Objective Scoring Evaluation (HOSE), Hypospadias Objective Penile Evaluation (HOPE) and Pediatric Penile Perception Score (PPPS) from Parents Perspective and Preference in COVID-19 Era

Introduction. Hypospadias is a common congenital abnormality. It may also be associated with other urogenital tract abnormalities. Literature has described more than 300 techniques being used. An objective evaluation is useful for attending doctor and parents to ensure both understands detection of complication and to assess post operative satisfaction from both sides are similar. Thus study sought to assess the outcome of hypospadias repair with objective scoring evaluation from parents’ perspective during COVID-19 era. Methods. This was a retrospective study of all patient post-hypospadias repair in Urology Unit, Hospital Universiti Sains Malaysia from January 2020 to December 2022 during the Covid-19 period. All patient medical records were reviewed. Data analyzed for demographic, surgical treatment, complications, and objective evaluation with HOSE, HOPE and PPPS questionnaire and parents preferred questionnaire to be used using Microsoft Excel for Windows 2003 and qualitative variables were presented as frequencies and simple percentages. Result. Hypospadias A total of 21 pediatric patients operated. The mean age during surgery was 7.2 years old. Distribution of glanular 6 patients, distal 3 patients and majority are proximal hypospadias with 12 patients (57.2%). Proximal hypospadias, 6 proximal penile and 6 penoscrotal. Single stage repair 18 patients and 2 patients had scrotoplasty performed and 3 patients had two stage repairs. Majority of single stage surgery performed was TIP and two stage repairs done with Bracka’s technique. Overall mean follow-up time 16.78 month. Three patients had UCF with 14.3%. Questionnaire with HOSE showed mean score 14.38. The HOPE questionnaire showed mean score of 54.71 and PPPS mean score was 10.2. Majority of parents preferred to use HOPE with 66.7% as compared to HOSE 14.3% and PPPS 19%. Discussion. This study has a small sample size possible due to very low rate for hypospadias in Malaysia and Covid-19 pandemic. Due to the pandemic, European Association of Urology recommended for repair before 18 months. However, if done after 2 years old showed significant predictor for complications. Validated questionnaires are useful and comparable to assess objectively both functional and patient satisfaction. However, HOPE might overestimate quality of cosmetic outcome compared with PPPS. Despite many available evaluation scoring systems were compared, reports show similar conclusions with none being more superior. Conclusion. Hypospadias requires complex surgery and complications are expected but should be within acceptable standards. In COVID-19 era, hypospadias repair had to be delayed and causes negative impact to patients. Despite many various techniques available, surgeons experience and technique preference are very important. There is no evaluation score more superior than another. It has its advantages and disadvantages. Parents satisfaction and functional outcome after repair should be routinely done for objective assessment.

Long term follow-up on young adults that underwent hypospadias repair through urethral advancement in childhood.

Assess the long-term outcome on cosmetic appearance, voiding, sexual function, and psychological impact of young adults operated by urethral advance (UA) technique in childhood. Patients over 14 years old, who underwent UA hypospadias repair in our centre (2000-2010) were evaluated. All patients presented mid-distal hypospadias with subcoronal or penile meatus and curvature lower than 20°. The cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed through 5 questionnaires. From 2000 to 2010, 143 children underwent UA hypospadias repair. 36 patients between 14 and 27 years were evaluated. The Hypospadias Objective Penile Evaluation (HOPE) showed an average of 8.75 (+/- 0.97), which indicates a good aesthetic result. Voiding dysfunction symptoms were assessed through the American Urological Association Symptom Index (AUASI) where 80.6% had none or mild symptoms and 19.4% had moderate symptoms. Only 11/36 patients were sexually active, according to the International Index of Erectile Function (IIEF-15) scale, none had erectile dysfunction, and their relationships were satisfactory. Assessment of the body perception through the Genital Perception Scale (GPS) was positive or very positive in 88.9% of the patients. However, the perception of their genitals was positive or very positive in 77.8%, there is a negative correlation between the perception of their body and genitals in 13.9% of the patients. Our results indicate that UA technique for hypospadias repair might be a valid option for the correction of mid-distal hypospadias when indicated.

Long-term impact of commonly performed operations in pediatric urology on reproductive and sexual health.

Sexual dysfunction is highly prevalent among men of reproductive age. Clinical practice guidelines have been established to assist providers in identification and education of patients who are at increased risk for infertility and sexual dysfunction with certain congenital and acquired urogenital disorders. The authors sought to review the reproductive and sexual health implications of treating common childhood urological conditions with commonly performed surgical procedures. To ensure the inclusion of influential and highly regarded research, we prioritized citations from the most-frequently cited articles on our respective review topics. Our inclusion criteria considered studies with substantial sample sizes and rigorously designed methodologies. Several topics were reviewed, including penile chordee, hypospadias, posterior urethral valves, varicoceles, undescended testicles, and testicular torsion. For chordee, surgical plication or corporal grafting may be employed. Erectile function remains unaltered post-surgery, while penile length may decrease after repair, which may be avoided using dermal grafts. Hypospadias repair hinges on severity and availability of the urethral plate. Those who underwent hypospadias repair report decreased penile length, but sexual satisfaction, libido, and semen quality are comparable to controls. Posterior urethral valves are usually treated with valve ablation. While valve ablation and bladder neck incision have not been found to affect ejaculatory function, high degree of concurrent renal dysfunction related to nephrogenic and bladder dysfunction may impact semen parameters and erectile function. Regarding varicocele, earlier management has been associated with better long-term fertility outcomes, and surgical intervention is advisable if there is observable testicular atrophy. Earlier repair of undescended testicle with orchiopexy has been found to improve fertility rates as well as decrease malignancy rates. Unilateral orchiectomy for testicular torsion without the ability for salvage has been shown to have decreased semen parameters but unaffected fertility rates. Infertility and sexual dysfunction are multivariable entities, with etiologies both congenital and acquired. At the same time, many common pediatric urology surgeries are performed to correct anatomic pathology that may lead to reproductive dysfunction in adulthood. This review highlights the need for diagnosis and management of pediatric urologic conditions as these conditions may impact long-term sexual function post-operatively.

The effectiveness of Zaontz urethral stent in hypospadias treatment in terms of children comfort according to the Parents' Postoperative Pain Measurement (PPPM) scale: A retrospective study

Aim: Advances in the techniques and materials used in hypospadias surgery are aimed at improving cosmetic and functional results. In our study, we aimed to compare the impact of using Zaontz urethral stent (ZUS) on patient comfort in children undergoing hypospadias surgery, as opposed to feeding tubes. Materials and Methods: A total of 178 patients who underwent distal hypospadias surgery were included in the study. Snodgrass technique was performed routinely in all cases. In all cases, 6 Fr, 8 Fr and 10 Fr urethral stents were used depending on the surgical situation. Patients were divided into two groups according to the catheterization method. While in Group 1, catheterization was performed with a feeding tube, ZUS was used in Group 2. Demographic data of the patients were analyzed. In the postoperative period, the groups were compared in terms of patient comfort according to the Parents' Postoperative Pain Measurement (PPPM) scale. This scale was evaluated three times a day during the hospitilation period. A score of at least 6 out of 15 was considered clinically significant pain. Results: Age, catheterization size, operation and hospitalization time were similar between the groups (p&gt;0.05). PPPM score in Group 2 was observed as 3.25, significantly lower than Group 1 (p&lt;0.001). Conclusion: As a result of our study, it was observed that ZUS would positively contribute to postoperative patient comfort in hypospadias repair.

Tubularized incised plate urethroplasty and grafted tubularized incised plate urethroplasty: systematic review, meta-analysis and trial sequential analysis

BackgroundHypospadias is one of the most common genital birth defects. There are around 300 various techniques available for the repair of hypospadias. This study aims to compare the reported outcomes...

A comparative study on primary hypospadias repair using dartos fascia flap versus tunica vaginalis flap in paediatric age group

A comparative study on primary hypospadias repair using dartos fascia flap versus tunica vaginalis flap in paediatric age group

Efficacy of Single-Stage Surgery (Island Tube Hypospadias Repair) in the Treatment of Proximal Hypospadias: A Comparative Retrospective Study

Efficacy of Single-Stage Surgery (Island Tube Hypospadias Repair) in the Treatment of Proximal Hypospadias: A Comparative Retrospective Study

The cosmetic outcome of distal penile hypospadias repair using stitch-by-stitch glanuloplasty versus TIP: a non-randomized retrospective study

The cosmetic outcome of distal penile hypospadias repair using stitch-by-stitch glanuloplasty versus TIP: a non-randomized retrospective study

Comparative study between polydioxanone 6.0 and polyglactin 6.0 suture material in distal hypospadias repair

Comparative study between polydioxanone 6.0 and polyglactin 6.0 suture material in distal hypospadias repair

Clinical efficacy of transverse preputial island flap urethroplasty for single-stage hypospadias repair in Children Hospital Faisalabad” A Retrospective Study.

Objective: To summarize the clinical outcomes of single stage hypospadias surgery with preputial-island flap method in the Children Hospital, Faisalabad. Study Design: Retrospective Study. Setting: Department of Paediatric Urology, Children Hospital, Faisalabad. Period: March 2018 to March 2023. Material &amp; Methods: First of all, approval of study from the Hospital Ethical Review Committee was taken for research work. For last five years, all patients of hypospadias repair were admitted in the ward via OPD of Pediatric Urology Department of Children Hospital, Faisalabad. According to inclusion and exclusion criteria, these patients were considered to be included in study. After analyzing the patients with history and physical examination, the diagnosis was confirmed and after the informed consent of surgery and consent of data for research purposes the patients were put in the research work. Results: There were one hundred and fifteen patients (n=115), who were operated using single stage hypospadias repair with method where we used dorsal prepuce in transverse manner as flap known as preputial-island-flap method during the study period time. The complication of surgery rate was found 48.7% in the study. There were five patients (4.34%) suffering from mild infection. Six patients (5.2%) had disruption of repair; secondary surgical correction was successful in all of them. Ten patients (6.7%) suffered necrosis and slugging of new urethral tube followed by disruption of repair. Urethro-cutaneous fistula was observed in sixteen patients (13-9%), it was single in eleven patients and the rest of five had more than one fistula. Four patients needed fistula repair, rest of the eleven healed with self-urethral dilatation, seven patients (6%) had meatal stenosis, while four patients (3.5%) had urethral stricture. Conclusion: Single staged hypospadias repair where dorsal prepuce in transverse manner were taken as flap known as preputial-island-flap is also an acceptable choice for surgery. Results of study showed transverse preputial-island-flap technique is an acceptable option. Because the vascularity of tube is intact and good, secondly results are better, thirdly this technique has lower rate of complications, fourthly we completed in single stage which was the time saving.

Quality of Hypospadias Surgery in a High Volume Hospital: Review of Short to Medium-Term Outcomes after Snodgrass Hypospadias Repair

OBJECTIVES The study aimed to review short-term and medium-term outcomes of Snodgrass repair from one-year to two-year follow-up. METHODOLOGY It’s a retrospective review of 114 patients (secondary data) with distal penile hypospadias without curvature who underwent Snodgrass repair performed by a single surgeon in the department of Urology, Lady Reading Hospital Peshawar from March 2021 to March 2022. Hypospadias objective score Evaluation (HOSE) was used for functional and cosmetic outcomes. RESULTSThe mean age at the time of presentation for surgery was 3 years. The mean documented follow-up was 13 months (2-23 months). 51% (58) of patients presented with coronal hypospadias, followed by sub-coronal, distal and glanular hypospadias. Overall complication rate was 10%. Three patients developed a total breakdown of their wounds that needed further staged procedures. Meatal stenosis was noted in three patients requiring meatal dilatation, and another two came back with non-obliterative strictures. One had gentle dilatation, and the other underwent an optical urethrotomy. The rest of the four patients developed urethrocutanoeus fistulae (UCF), ultimately getting repaired 6 months postoperatively. Good cosmetic and functional results were achieved in 93% of cases (HOSE score of 14 or above). CONCLUSION This study shows that Snodgrass repair is the best option for mainly correcting distal penile and midshaft hypospadias and has an acceptably low complication rate with better short to medium-term outcomes.

Post-operative Dressing for Paediatric Hypospadias Repair

The optimal dressing is still unclear, despite hypospadias being one of the most prevalent surgical operations. Children’s dressing for hypospadias surgery was searched on PubMed as “dressing for hypospadias,” “postoperative dressing for pediatric hypospadias,” and “dressing AND hypospadias.” Experimental studies, animal studies, reviews, letters, and repetitive publications were excluded from the study. By evaluating these reviewed publications, factors affecting hypospadias dressing, such as surgeon, country, dressing type, characteristics, and why it is preferred, will be revealed. As a result, 17 articles were examined, and the advantages of each were established by examining the results. The type of hypospadias, the surgeon’s choice, and its ease of removal stand out as the crucial factors in treating hypospadias in children, along with the degree of development of the nation.

Male refractory hypospadias with sexual reversal: a case report

BackgroundHypospadias is one of the most prevalent urogenital malformations in clinic. However, some hypospadias may have a more complex disorder of sex development. Usually, hypospadias in these patients is severe. Among them, the 46,XX male sex reversal syndrome is a rare disorder of sex development, and this may be the main reason for this type of hypospadias being difficult to repair.Case presentationWe present a Han nationality 19-year-old male with failure of repeated repair of hypospadias. No sperm was found on semen analysis. Lingual mucosal graft was carried out for this patient. It still did not succeed after using lingual mucosal graft repair. Karyotype analysis of this patient confirmed 46,XX karyotype.ConclusionHypospadias with 46,XX male sex reversal syndrome is hard to repair. Chromosome karyotype examination in patients with hypospadias is suggested. Genetic testing is recommended. In the future, further research is needed on the pathogenesis of disease and how to treat and prevent it.

Is antibiotic prophylaxis generally safe and effective in surgical and nonsurgical scenarios? Evidence from an umbrella review of randomized controlled trials.

The authors aimed to comprehensively evaluate the efficacy and safety of antibiotic prophylaxis through surgical and nonsurgical scenarios and assess the strength of evidence. The authors performed an umbrella review of meta-analyses of randomized controlled trials (RCTs). An evidence map was created to summarize the absolute benefits of antibiotic prophylaxis in each scenario and certainty of evidence. Seventy-five meta-analyses proved eligible with 725 RCTs and 78 clinical scenarios in surgical and medical prophylaxis. Of 119 health outcomes, 67 (56.3%) showed statistically significant benefits, 34 of which were supported by convincing or highly suggestive evidence from RCTs. For surgeries, antibiotic prophylaxis may minimize infection occurrences in most surgeries except Mohs surgery, simple hand surgery, herniorrhaphy surgery, hepatectomy, thyroid surgery, rhinoplasty, stented distal hypospadias repair, midurethral sling placement, endoscopic sinus surgery, and transurethral resection of bladder tumors with only low to very low certainty evidence. For nonsurgery invasive procedures, only low to very low certainty evidence showed benefits of antibiotic prophylaxis for cystoscopy, postoperative urinary catheterization, and urodynamic study. For medical prophylaxis, antibiotic prophylaxis showed greater benefits in nonemergency scenarios, in which patients were mainly with weakened immune systems, or at risk of recurrent chronic infections. Antibiotics prophylaxis may increase antibiotic resistance or other adverse events in most scenarios and reached significance in cystoscopy, afebrile neutropenia following chemotherapy and hematopoietic stem cell transplantation. Antibiotic prophylaxis in surgical and nonsurgical scenarios is generally effective and seems independent of surgical cleanliness and urgency of diseases. Its safety is not well determined due to lack of available data. Nevertheless, the low quality of current evidence limits the external validity of these findings, necessitating clinicians to judiciously assess indications, balancing low infection rates with antibiotic-related side effects.

Plate Objective Scoring Tool (POST) in distal hypospadias: Correlation with post-repair complications

The Plate Objective Scoring Tool (POST) accurately reflects configuration of the urethral plate in distal hypospadias. Here we assessed whether POST score also correlates with patient risk of complications after surgical repair. Data were obtained prospectively from pre-pubertal boys who underwent primary hypospadias repair between January 2020 and February 2023. Both POST and Glans-Urethral Meatus-Shaft (GMS) scores were determined in triplicate by three independent reviewers before evaluating correlation with complications after surgery. POST ratios were strongly correlated with incidence of post-repair complications in n=121 patients. Mean POST score was 1.10 (range 0.5-1.62) and average GMS value was 5.29±1.36 (median G=2, M=2, S=1). Bivariate correlation analysis indicated that POST score can accurately predict risk of complications after surgery (Pearson correlation coefficient r=0.821 [0.724-0.918], 95% CI). A POST threshold of 1.2 provided the highest specificity for risk of post-operative complications, which occurred in 4.4% of patients with POST score ≥1.2 (2/45 cases), compared with 25% among patients with POST score <1.2 (19/76 cases). This study confirms that POST index can be used as a surrogate marker of urethral plate quality and accurately predicts the outcome of distal hypospadias repair. Objective scoring of POST revealed that low ratios were significantly associated with high risk of postoperative complications. In future, this approach could be used to stratify patients and better identify cases that require close follow-up care.