title: Anterior hypospadias. Is repair necessary with urination in a sitting or squatting position?
abstract: OBJECTIVE
  To determine the chronic complication rate of anterior hypospadias repair and to explore whether the practice of placing the neomeatus at the tip of the penis should be applicable to all cases in our community where urination is in a sitting/squatting position.
  
  
  METHODS
  Over a 10-year period commencing 1st September 1987, 312 patients had hypospadias repair of whom 72% had anterior hypospadias. The meatus was advanced to the tip of the penis in all repairs. The location of the meatus was also determined in 281 non-complaining men with a straight penis and normal sexual and reproductive functions. Following prior information that anterior hypospadias was not associated with sexual and reproductive dysfunction, 51 patients were given a choice between repair or no repair.
  
  
  RESULTS
  Urethrocutaneous fistula occurred in 5% of patients, urethral stricture in 3% and meatal retraction in 3%, with 92% of patients having no complications. Forty six percent of non-complaining men had the meatus in locations other than the tip of the penis. Of 51 patients with the benefit of informed consent, 73% opted for no repair.
  
  
  CONCLUSIONS
  Our results of anterior hypospadias repair compare favourably with those of other centers. Placement of the meatus at the tip of the penis for anterior hypospadias should not be applicable to all patients in this community where urination is in a sitting/squatting position. Before such repairs, an informed consent is warranted by making the patients and their parents aware of the non-association of sexual and reproductive disorders with these anomalies.
authors.affiliation: Department of Urology and Plastic Surgery, King Fahd Hospital of the University, King Faisal University, Al-Khobar, Kingdom of Saudi Arabia.
authors.forename: R M
authors.initials: RM
authors.lastname: Anikwe
authors.forename: B A
authors.initials: BA
authors.lastname: Kamal
authors.forename: M M
authors.initials: MM
authors.lastname: Hegazi
authors.forename: M
authors.initials: M
authors.lastname: Hashish
authors.forename: H
authors.initials: H
authors.lastname: El-Darawani
authors.forename: S A
authors.initials: SA
authors.lastname: Taha
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003075:Coitus; D017577:Cutaneous Fistula / Q000209:etiology; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D007021:Hypospadias / Q000503:physiopathology* / Q000601:surgery*; D007223:Infant; D007258:Informed Consent; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011187:Posture; D013524:Surgical Flaps; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000209:etiology; D014525:Urethral Stricture / Q000209:etiology; D014548:Urinary Fistula / Q000209:etiology; D014554:Urination