Niklaus was born with hypospadias; which of the following should be avoided when a child has such condition?
A. Surgery
B. Circumcision
C. Intravenous pyelography (IVP)
D. Catheterization
Correct Answer: B. Circumcision
Hypospadias refers to a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface (underside) of the penile shaft. The ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early recognition is important so that circumcision is avoided; the foreskin is used for surgical repair.
Option A: Surgery is the procedure of choice to improve the child’s ability to stand when urinating, improve the appearance of the penis, and preserve sexual adequacy. Patients diagnosed with hypospadias should be referred for surgical evaluation within the first weeks of life. If parents want circumcisions for their newborns, the presence of any penile abnormality should contraindicate the procedure, given that the foreskin is used in arthroplasties.
Option C: IVP is contraindicated if the child has an allergy to iodine or shellfish. Intravenous pyelography (IVP), or intravenous urography, is a diagnostic test that involves the administration of intravenous contrast and X-ray imaging of the urinary tract.
Option D: Catheterization may be used to ensure urinary elimination. Hypospadias is the most frequent anatomical variant of the penis and occurs during development when hormonal triggers malfunction and the urethra does not properly tubularize. The urethral meatus can be found anywhere along the glans, penile shaft, scrotum, or perineum, leading to a difficult catheterization.