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Am Fam Physician. 1999;60(7):1933

to the editor: We would like to point out that in the examination of a neonate with apparent hypospadias, physicians should not overlook observing the neonate actually voiding.

We encountered a six-month-old infant who appeared to have a hypospadias with the orifice close to the penoscrotal junction (see the accompanying figure). Observation of the infant during micturition revealed that the true orifice was located in the glans. The apparent lower orifice was only a cosmetic defect, and a hypospadias repair was not indicated.

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For physicians considering whether hypospadias repair is advisable, we believe there are some reports in the literature that warrant consideration. Mureau and colleagues1 studied patients who underwent hypospadias repair as infants. The postoperative reports stated satisfactory results. As adults, the patients were queried if they were satisfied with the results of their surgery. The study reports that “there was hardly any agreement between patient and surgeon satisfaction. . . . Patients were less satisfied.”

Fichtner and colleagues2 studied meatal location in 500 “normal” men. They concluded that “the meatal location varied widely with only 55 percent of all meatus at the tip of the glans and significant hypospadias in patients without complaints about cosmetic or functional aspects. . . . These observations might question the need for meatal advancement in cases of anterior hypospadias without associated penile curvature.”

It is apparent from these reports that hypospadias does not always require repair. In addition, appearances may be deceiving and an apparent meatus may be only a dimple.

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