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Marrocco et al. (2004) explain that this early intervention is possible as: in general, the younger the child, the less discomfort following repair is documented Marrocco et al. (2004) also recommend early surgery following their observation of an increased rate of complications in patients older than 1 year. The success of hypospadias repair can be measured according to functional results, such as urinary flow rate, straight urine stream and lack of urinary tract infection (UTI), as well as a normal appearance of the penis, with a slit-like meatus at the tip of the glans (Baskin, 2001). Applying these criteria Baskin achieved results that ��appeared normal�� from 76% for proximal hypospadias repairs to 82% for boys with distal hypospadias. For patients with complex repeat repairs he states that in 60% the result would be a normal appearance of the penis. Woodhouse and http://www.selleckchem.com/products/Cyclopamine.html Christie (2005) emphasize the need for clarity of what surgery can achieve and what is beyond the surgeon's scope. This is important because hypospadias repairs have limitations, the multitude of described (and often subsequently abandoned) procedures make that very clear. Although ��success�� rates are high each single negative outcome is devastating for the individual. The general appearance of the penis including meatal position, shape of the glans and scrotum as well as scarring can normally be corrected. However, all authors who consider the http://www.selleck.cn/products/gsk126.html issue concur that surgery cannot increase penis size or thickness. Instead, this is asserted to be a consequence of underdevelopment rather than surgery (Van der Werff and Ultee, 2000). Therefore, all those involved need to realize the limits of hypospadias surgery, especially as any disagreement between health professionals and patients or parents normally centres on those areas that remain uncorrectable (Woodhouse and Christie, 2005). Given the high importance of satisfactory outcomes, an objective way to judge all aspects of hypospadias repair is required. Holland et al. (2001) validated Hypospadias Objective Scoring Evaluation http://www.selleckchem.com/products/BI-2536.html (HOSE, see Table 3) is an objective scoring system that includes five components: a single urinary stream The authors consider a score of 14 or more to indicate an acceptable outcome. Although initially developed to document the results of hypospadias surgery, this scoring system could also be used prior to surgery to assess the initial severity of the hypospadias. Similarly, the tool could be used to improve the communication between health professionals and parents (as well as patients where this is appropriate). Improvements could involve the inclusion of further criteria. The authors themselves emphasize that the retention of the foreskin could be considered in cultures where this is considered significant. Furthermore, the absence of a chordee, the condition of the ventral skin and the absence of any excess dorsal skin could be included (Asmy, 2004).