Hypospadias is a birth defect which affects 1 in 200 boys in the United States. There is significant ambiguity regarding the severity levels, effective procedures, and identification of high risk anatomy.

Two main objectives were researched to solve this issue. Determine if dorsal inlay grafts (DIGs), in comparison to Thiersch Duplays (TDs), reduce postoperative complication in distal hypospadias patients with a flat, unfavorable or intermediate glans groove. Standardize severity categorization of hypospadias cases through objective measurement strategies.

A retrospective review of cases was taken from 2016-2025. The data collection included surgical repair type, complication type, follow-up type, preoperative testosterone dose, glans measurements, length of urethroplasty, and chordee. A prospective review of cases was taken from June 2025 to August 2025. Data collection occurred across 13 surgeons including patient weight, age, urethral calibration, glans measurements, urethral meatus measurements, POST score, bridging tissue, and chordee.​

Out of 285 patients who met the criteria and underwent repair 213 (74.74%) were TDs and 72 (25.26%) were DIGs. TDs had a 19.2% complication rate, while DIGs had a 8.3% complication rate. This displays a significant difference (p=0.03)​​. Out of 34 patients in the anatomy project, 41% have favorable glans and 21% have unfavorable glans. ​

By correctly classifying hypospadias patients as higher risk and performing favorable surgical techniques, the best results can be assured. Data collected on 34 patients will be used to create a group consensus for future use in anatomic descriptors for standardized patient assessment.