Improving care for distal hypospadias: recent studies provide a blueprint for improved diagnostics and optimized operative outcomes

PURPOSE OF REVIEW: Recent clinical studies provide key insights into our current approach to the management of distal hypospadias. This common condition has known long-term complications; identification of optimal approaches to identification, assessment of anatomic landmarks, and optimal technical selection can be used to benefit our large population of these patients. RECENT FINDINGS: Mediators of androgen disruption have been implicated in distal hypospadias pathogenesis. Anatomic assessments are increasingly using app-based technology and deep learning to plan repair. Home-based postoperative care is being increasingly shown to be feasible, safe, and effective while supporting patient satisfaction. SUMMARY: The care of distal hypospadias has continued to rapidly evolve over the past year. Surgeons should strongly consider care pathways that involve support of the families at home to remove stents and dressings, coverage of urethroplasties with a dartos flap and possibly adjunctive biomaterials, and long-term care pathways that include monitoring of functional and psychosexual outcomes.