Commentary to ‘‘Outcome of severe hypospadias repair using three different techniques’’

What defines ‘severe’ hypospadias? The authors describe those having ‘proximal division of the corpus spongiosum’, but others might consider penoscrotal to perineal hypospadias the ‘severe’ cases, while another definition in this era of urethral plate-based urethroplasty might be those whose ventral curvature leads to plate transection. Less ambiguous terms are needed for surgeons to clearly communicate their experiences to each other. Consider the illustrations: few would disagree that the perineal hypospadias in Fig. 1 qualifies as a ‘severe’ case, but Fig. 2 appears to show a distal shaft meatus few would classify ‘severe’. Discussion regarding ‘hypoplastic tissues’ and ‘quality of the urethral plate’ adds more subjective terms likely to be interpreted by readers differently. The problem is not unique to this report, nor to these authors, but for hypospadiology to progress we all must describe our patients and interventions as clearly as possible so that other surgeons can understand what is being done to whom. Proximal shaft to perineal hypospadias frequently is associated with ventral curvature. We recently reported findings in 70 consecutive patients: 19% were straight after degloving, 31% underwent a single dorsal plication for curvature< 30 and the remaining 50% had curvature > 30 [1]. In contrast, the authors state that only 10% of their primary cases had ventral curvature that apparently was usually <30 , as most were corrected by dorsal plication. Again the question arises: how many of their patients had ‘severe’ hypospadias?