Any adult patient with primary or fail hypospadias should be carefully examined to assess the severity of the condition and to identify any associated malformations.
Firstly, the site of urethral opening should be clearly identified, as well as any other abnormal openings (fistulae) that are common after a previous failed surgery. Urethrogram is very useful to assess the status of proximal urethra which can be compromised or narrow as well. Methylene blue dye injection onto the external meatus also facilitate the identification of fistulae. Secondly, penile curvature should be clearly identified before surgery. Patients should send pictures of the penis in full erection to allow the assessment, the severity and the direction of the deformity. Thirdly, penile skin should be carefully examined before planning the surgery, as hypospadias patients frequently present a deficit of penile skin on the ventral surface.
The examination is completed with the palpation of both the testis and the assessment of the suprapubic fat hypertrophy. The presence of other dermatologic diseases, such as lichen sclerosus, should be ruled out in this phase.
If patient received a previous surgery for hypospadias, it is better to search for previous records, and if possible, hand carry the operative notes of the previous surgeries at the first visit. It will be very useful to know if buccal mucosa graft has been previously harvested or if penile skin has been previously used to repair the urethra.
