OBJECTIVE: To evaluate the risk of urologic adverse events (UAE), including ureteral complications and urinary fistula, in women treated for cervical cancer to inform clinical decision-making and improve survivorship qua...OBJECTIVE: To evaluate the risk of urologic adverse events (UAE), including ureteral complications and urinary fistula, in women treated for cervical cancer to inform clinical decision-making and improve survivorship quality of life. METHODS: Using the Merative MarketScan database (2011-2021), patients with cervical cancer were identified. Exclusions included <1 year pre-diagnosis enrollment, prior radiotherapy, pre-existing UAE, or multiple gynecologic cancers. Patients were categorized by treatment: surgery alone, surgery + chemotherapy, radiation ± other therapies, no/local treatment, and chemotherapy or radiation alone (surrogate for metastatic disease). Healthy age-matched controls were used. Multivariate Cox models and Kaplan-Meier analyses estimated UAE risk over time. UAEs were stratified as low-, intermediate and high-grade events. RESULTS: Among 96,522 patients (68,990 cases and 27,532 controls), higher rates of all UAE were observed in cervical survivors than controls (23.2% vs 17.9%, P < .001). The highest risks of UAE were observed in patients with presumed non-metastatic disease who received radiation (low-grade UAE: HR 3.7, P < .001; intermediate-grade: HR 9.6, P < .001; high-grade UAE: HR 13.7, P < .001, ureteral: HR 23.5, P < .001, and fistula: HR 63.3, P < .001). CONCLUSION: Cervical cancer treatment, particularly involving radiation, is associated with substantial risk high-grade UAE, ureteral and fistula complications. For young patients with localized and presumably curable disease, improved counseling, monitoring, and research to mitigate these highly morbid urologic complications is imminently warranted.
OBJECTIVE: The fibrinogen-to-albumin ratio (FAR) is a new marker used in inflammatory processes and is effective in demonstrating associated microvascular damage. The aim of this study was to evaluate the relationship be...OBJECTIVE: The fibrinogen-to-albumin ratio (FAR) is a new marker used in inflammatory processes and is effective in demonstrating associated microvascular damage. The aim of this study was to evaluate the relationship between FAR and erectile dysfunction (ED), a sexual intercourse disorder associated with inflammatory processes and endothelial dysfunction. METHODS: Data from 1876 patients presenting with ED between January 2020 and 2025 were evaluated. A total of 424 patients, 214 in the ED group and 210 in the control group, were included in the study. Anthropometric measurements and biochemical examinations of the patients were recorded. FAR values were compared between the ED group, ED subgroups, and the control group. The cut-off value for the FAR value and the potential correlation between ED severity were examined. RESULTS: The FAR value was calculated as 89.4 ± 27.3 in the ED group and 67.8 ± 18.8 in the control group (p < 0.001). The optimal cut-off value for FAR was found to be 101.49 with 33% sensitivity and 99% specificity. FAR values were significantly higher in the ED subgroups compared to the control group. A moderate linear correlation was found between IIEF-5 scores and FAR values (r = -0.554, p < 0.001). The FAR value (AUC = 0.724) was found to be more successful in distinguishing between diseased and healthy individuals than CAR (AUC = 0.647), a similar inflammatory marker. CONCLUSION: It has been shown that FAR is significantly associated with the presence and severity of ED and can be a reliable and easily accessible marker to support the diagnosis of ED.
To characterize urinary and sexual outcomes following temporary implantable nitinol devices (iTind; Olympus, Japan) therapy for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through...To characterize urinary and sexual outcomes following temporary implantable nitinol devices (iTind; Olympus, Japan) therapy for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) through a systematic review and single-arm meta-analysis. PubMed, Embase, and Cochrane Central databases were queried for prospective studies of men with LUTS/BPH treated with iTind. Primary outcomes were change-from-baseline in the International Prostate Symptom Score (IPSS), IPSS quality-of-life (IPSS-QoL), maximum urinary flow rate (Qmax), post-void residual volume (PVR), and Sexual Health Inventory for Men (SHIM/IIEF-5) score. Ejaculatory function was also assessed. Pooled random-effects meta-analysis was performed. Five prospective studies (431 patients) were included. 12-month pooled change-from-baseline results: IPSS was -10.44 points (95% CI -11.79 to -9.09; k = 4, I = 74%). IPSS-QoL was -2.08 points (95% CI -2.22 to -1.93; k = 4, I = 0%). Qmax was +5.38 mL/s (95% CI +3.25 to +7.51; k = 4, I = 93%). PVR was -12.21 mL (95% CI -24.27 to -0.16; k = 3, I = 77%). Two studies (n = 198) reported SHIM/IIEF-5 scores; Pooled analysis at 1 and 3 months was +0.68 points (95% CI -1.54 to +2.90; k = 2, I = 75%) and +1.19 points (95% CI -1.42 to +3.80; k = 2, I = 82%), respectively, indicating no statistically significant change in erectile function. Ejaculatory function was preserved, with no de novo retrograde ejaculation. 12-month surgical reintervention rates ranged from 0% to 4.7%. iTind produces consistent, clinically meaningful improvements in urinary outcomes through 12 months. Ejaculatory function was preserved in all studies, and erectile function showed no significant change. Comparative trials with validated sexual function instruments are warranted.
PURPOSE: Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative cours...PURPOSE: Longitudinal patient-reported outcomes comparing radical prostectomy (RP) and radiation (RT) for localized prostate cancer (CaP) in low- to middle- income countries are limited. We examined the comparative course of depression and anxiety and their association with health related quality of life (HRQOL) in men treated with RP or RT over a year post-treatment. METHODS: Data from 161 South African (SA) men with CaP were analysed. Depression, Anxiety, HRQOL, and relevant covariates were measured at baseline, 3, 6, 9, and 12 months. We used the following validated scales: Centre for Epidemiologic Studies Depression (CES-D), State Trait Anxiety Inventory (STAI-S), European Organisation for Research and Treatment in Cancer Quality of Life (EORTC QLQ-PR25), Multidimensional Scale of Perceived Social Support (MSPSS), Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Connor-Davidson Resilience Scale (CD-RISC), and Decisional Conflict Scale (DCS). RESULTS: Depressive symptoms (CES-D ≥ 16) remained elevated 12 months post-RP (baseline: 43%; 3-month: 37%; 6-month: 47%; 12-month: 42%), while RT prevalence declined (39% to 29%). Similarly, anxiety (STAI-S ≥ 39) was more prevalent and persistent in the RP group (29% to 23%; 6-month peak: 28%) compared to the RT group (26% to 15%), where scores consistently declined throughout the first year. Overall urinary morbidity was marked in the first six months (β = 11.828; 95% CI: 7.931to 15.73; p < 0.001). More men in the RP group exhibited higher incontinence aids use (β = -21.477; 95% CI: to 33.261 to 9.694; p < 0.001). Sexual function in RP was lower (β = 18.006; 95% CI: 6.881 to 29.131; p = 0.002) with increased sexual activity from month nine onwards (β = -13.203; 95% CI: -23.489 to -2.916; p = 0.012). RT was associated with bowel symptoms in the latter half of follow-up. (4.681; 95% CI: 0.702 to 8.659; p = 0.021). Depression and anxiety adversely affected all HRQOL functional and symptom domains except sexual activity. CONCLUSION: The high prevalence of depression and anxiety reflects marked psychological morbidity in men treated for CaP in the first year post-treatment. Given the substantial association between psychological impairment and HRQOL, integrating mental health screening, management and referral into uro-oncology protocols is critical.
OBJECTIVE: To evaluate the effectiveness and generalizability of a new morbidity and mortality conference (MMC) model to improve educational value and increase opportunities for systems change in an inclusive, nonjudgmen...OBJECTIVE: To evaluate the effectiveness and generalizability of a new morbidity and mortality conference (MMC) model to improve educational value and increase opportunities for systems change in an inclusive, nonjudgmental manner. METHODS: This prospective, multi-institutional study evaluated the implementation of a novel MMC model among three geographically diverse academic urology departments. Each institution received training in implementing the M-PROVE model. Participant perceptions of the conference were assessed using 5-point Likert scale surveys administered at baseline and 3 months post-intervention, and responses were compared using two-tailed unpaired Student t-tests. Program leadership was also surveyed post-intervention on implementation feasibility. RESULTS: Sixty-five pre-intervention responses and 54 post-intervention responses were collected. Results demonstrated significant improvement across all questions focusing on quality/relevance, practice/systems change, inclusiveness, educational value, and satisfaction. The question related to MMCs being a nonthreatening environment showed improvement, but did not reach statistical significance. The average score across all questions improved from 3.70 to 4.17 (P < .001). Attendee role, gender, and the number of conferences attended did not affect the differences. Postintervention feasibility surveys revealed ease with adoption, worthwhile implementation, and continued use of M-PROVE. Challenges included faculty recruitment and time restraints. CONCLUSION: A novel, standardized morbidity and mortality conference focused on education, inclusion, systems change, and quality improvement can be successfully expanded to geographically distinct academic institutions with similar improvement in conference attendee satisfaction and perceived value of the conference.
OBJECTIVE: To evaluate prostate-specific antigen (PSA) screening patterns among gay and bisexual men and identify factors associated with screening uptake in this population. METHODS: We conducted a cross-sectional analy...OBJECTIVE: To evaluate prostate-specific antigen (PSA) screening patterns among gay and bisexual men and identify factors associated with screening uptake in this population. METHODS: We conducted a cross-sectional analysis using 2023 Behavioral Risk Factor Surveillance System (BRFSS) data from 8 states and 1 territory that administered key survey modules. Cisgender men aged ≥ 40 years identifying as gay, bisexual, or straight with no prostate cancer history were included. Gay and bisexual men were matched with straight men using propensity scores based on demographics. Predictors of PSA screening within 2 years were assessed with multivariable regression. RESULTS: Of 19,925 respondents, 593 identified as gay or bisexual; 49.8% reported recent PSA screening compared with 46.2% of straight men. Sexual orientation was not associated with screening differences (P = .084). Clinician-led discussion was the strongest predictor (adjusted odds ratio [aOR] 5.45; P<.001), while uninsured status (aOR 0.39; P= .007) and no check-ups within 2 years (aOR 0.11; P <.001) were linked to lower rates of screening. Among gay and bisexual men, age 55-69, discussion of testing, college education, and recent check-ups were associated with increased screening rates. CONCLUSION: Prostate cancer screening rates did not differ significantly by sexual orientation, suggesting that clinician communication, insurance coverage, and primary care continuity are stronger predictors of PSA testing. Enhancing provider communication through LGBTQ+-affirming training and strengthening primary care continuity may improve early detection of prostate cancer across diverse populations.
BACKGROUND: This prospective randomized study aimed to assess the effect of self-selected music, delivered via loudspeaker, on early postoperative anxiety and pain in patients who underwent anatomical endoscopic enucleat...BACKGROUND: This prospective randomized study aimed to assess the effect of self-selected music, delivered via loudspeaker, on early postoperative anxiety and pain in patients who underwent anatomical endoscopic enucleation of the prostate (AEEP) under spinal anesthesia without sedation. METHODS: Adult male patients scheduled for AEEP were randomly allocated to either a music intervention group (self-preferred music) or a control group (no music). Baseline characteristics, preoperative urethral catheter status, International Prostate Symptom Scores (IPSS), operative duration, and pre- and postoperative anxiety scores (State Anxiety Inventory, SAI) were recorded. Visual Analog Scale (VAS) was used to evaluate postoperative pain two hours after surgery. RESULTS: A total of 135 patients were analyzed (music group, n= 67; control group, n= 68). Baseline characteristics and operative times were comparable between groups (p>0.05). The music group had significantly lower postoperative SAI (32.0 ± 7.32 vs. 38.38 ± 11.28; p = 0.001) and VAS scores (1 [1-2] vs. 2 [1-3]; p = 0.001). The reduction in postoperative SAI compared to preoperative value was also greater in the music group (14 [10.00-21.00] vs. 7 [1.00-11.75]; p = 0.001). Music type had no significant impact on outcomes (p>0.05). In multivariate analysis, music intervention and preoperative catheterization were independent predictors of postoperative anxiety. CONCLUSIONS: Self-selected music intervention significantly reduced early postoperative anxiety and pain following AEEP under spinal anesthesia. Given its simplicity and non-invasive nature, music may serve as an effective adjunct for enhancing patient comfort, regardless of music genre. CLINICAL TRIAL NUMBER: NCT07255118.
OBJECTIVE: To determine if female vegetarians and vegans have a lower rate of recurrent urinary tract infection (rUTI) compared to non-vegetarians, as different strains of bacteria may colonize the gut based on dietary f...OBJECTIVE: To determine if female vegetarians and vegans have a lower rate of recurrent urinary tract infection (rUTI) compared to non-vegetarians, as different strains of bacteria may colonize the gut based on dietary factors, with less virulent strains in those who eat a plant-based diet. METHODS: We performed a cross-sectional study of participants in the Adventist Health Study-2 (AHS-2) from whom detailed dietary and urinary history were collected. Participants were classified as vegan, lacto-ovo-vegetarian, pesco-vegetarian, and non-vegetarian. Within the AHS-2 study, there was also an assessment of UTI history. Other variables included were: age, BMI, race, diabetes, and menopausal status. RESULTS: 57,252 women had complete data. Average age was 58 years. More than half (53.7%) of participants were non-vegetarian, 28.5% lacto-ovo-vegetarian, 10.3% pesco-vegetarian and 7.5% vegan. A history of rUTI was reported by 13.1%. Risk of rUTI increased with age, non-Black race, higher BMI, diabetes, and menopause. The rate of reported rUTI significantly varied with diet: the highest prevalence of rUTI was in non-vegetarians (14.2%), followed by pesco-vegetarians (13.5%), lacto-ovo-vegetarians (11.6%), and vegans (10.3%, P < .001). On multivariate regression, age, race, diabetes, and menopause remained significant factors associated with rUTI. Additionally, diet maintained a statistically significant association with rUTI, with lacto-ovo-vegetarians and vegans at lower risk than pesco-vegetarians and non-vegetarians. CONCLUSION: Compared to nonvegetarians, lacto-ovo-vegetarians and vegans have a 23% and 31% lower association of rUTI. In an age of increasing bacterial resistance, non-antibiotic prophylactic interventions with dietary modification to a more plant-based diet may add to the armamentarium for managing rUTI.
OBJECTIVE: To qualitatively assess applicant perspectives on urology residency application and match cycle processes, which may be of unique value to urology program directors as their decisions steer the future directio...OBJECTIVE: To qualitatively assess applicant perspectives on urology residency application and match cycle processes, which may be of unique value to urology program directors as their decisions steer the future direction of the urology match. METHODS: Applicants to our residency program from the 2024 to 2025 American Urological Association match cycle were surveyed. Descriptive statistics were tabulated overall and for a qualitative cohort who answered optional free-text response questions. Qualitative data were analyzed with an inductive, grounded theory approach. The primary aim was to assess applicant preferences and experiences by interview format. Secondary aims included assessing use of social media, applicant assessments of fit with residency programs, and suggested changes or improvements to the match cycle. RESULTS: Response rate was 45% (75/166), with 47 (63%) in the qualitative cohort. Detailed results of qualitative analyses are presented in Tables 2-5, organized by emergent theme. Applicants preferred in-person interviews, both overall and when judging fit with programs. However, most were concerned that costs and travel presented a barrier, feeling that programs should offer more financial aid. Some proposed innovative solutions, like regional clustering of interview dates. For gathering information, most applicants preferred program websites over social media, despite noting that these websites often containing outdated and inadequate information. CONCLUSION: As the urology match cycle continues to evolve, so too do applicant preferences. With in-person interviews once again favored, program directors must utilize both qualitative and quantitative data to overcome the hurdles present as they shape better and more equitable future experiences for all applicants and programs alike.
OBJECTIVE: To explore rates of serious adverse outcomes (sepsis, hospital admission, and death) in women with rUTI who were prescribed vs not prescribed vaginal estrogen. METHODS: We used the Epic Cosmos database to iden...OBJECTIVE: To explore rates of serious adverse outcomes (sepsis, hospital admission, and death) in women with rUTI who were prescribed vs not prescribed vaginal estrogen. METHODS: We used the Epic Cosmos database to identify women with rUTI, which we defined as 2 separate coded UTIs within 1-6 months. Vaginal estrogen prescription classification was either (1) never received or (2) received within 2 months of the second UTI. Outcomes were assessed within 8 years of inclusion (second UTI with or without a documented prescription) and included sepsis, hospital admission, and all-cause mortality. Age-stratified odds ratios (OR) with 95% confidence intervals (CI) were calculated. RESULTS: Of 1,891,956 females with rUTI, 97,109 (5.1%) received a prescription within 2 months and 1,794,847 (94.9%) did not. Across age groups (20-39, 40-54, 55-69, and 70-99 years), vaginal estrogen prescription was associated with lower odds of sepsis, hospitalization, and death. Sepsis occurred in 4.2%-10.4% of estrogen recipients vs 8.5%-24.1% of nonrecipients (OR 0.2-0.5 across age groups). Hospitalization occurred in 7.5%-12.0% of recipients compared with 15.7%-27.5% of nonrecipients (OR 0.3-0.6). Mortality increased with age in both groups but remained lower among estrogen recipients at 0.3%-3.9% vs 0.8%-9.6% in nonrecipients (OR 0.2-0.4 across age groups). CONCLUSION: Vaginal estrogen prescription within 2 months of rUTI diagnosis is associated with lower odds of serious adverse outcomes across age groups.
OBJECTIVE: To explore provider-perceived barriers to delivering psychosocial care throughout the perioperative cystectomy pathway and identify opportunities for system-level improvement. Despite increasing recognition of...OBJECTIVE: To explore provider-perceived barriers to delivering psychosocial care throughout the perioperative cystectomy pathway and identify opportunities for system-level improvement. Despite increasing recognition of the psychological burden of bladder cancer and radical cystectomy, structured mental health support remains inconsistently integrated into uro-oncology care. METHODS: Four semi-structured focus groups were conducted with nurse navigators, ostomy nurses, and urology advanced practice providers (n = 14) at a high-volume academic center. Discussions explored perceptions of patient distress, workflow barriers, and opportunities to integrate psychosocial support into routine care. Transcripts were analyzed using a hybrid inductive-deductive approach with reflexive thematic analysis, supported by NVivo and the Sort & Sift, Think & Shift method. RESULTS: Providers identified 3 interrelated system-level barriers to consistent psychosocial care: (1) limited role clarity and training in addressing psychological distress, (2) fragmented communication and diffuse ownership across multidisciplinary teams, and (3) non-standardized resources compounded by workforce and time constraints. These barriers contributed to inconsistent distress recognition, delayed referrals, and reliance on informal, provider-dependent approaches to behavioral health support. CONCLUSION: Providers recognize the psychological burden of cystectomy but face structural barriers that limit consistent delivery of psychosocial care. Embedding standardized screening, clarifying care ownership, and integrating accessible behavioral health resources within clinical workflows may enhance patient-centered outcomes and improve continuity of care.
BACKGROUND: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular dise...BACKGROUND: Transurethral resection of the prostate (TURP) is s the gold standard surgical treatment method for benign prostatic hyperplasia. With the aging population and the increasing prevalence of cardiovascular diseases, the number of patients requiring anticoagulant (AC) or antiplatelet (AP) therapy continues to rise. The perioperative management of these medications remains challenging because continuation may increase bleeding complications, whereas discontinuation may increase thromboembolic risk. In this study, we evaluated bleeding-related outcomes after TURP in patients receiving chronic AP or AC therapy undergoing perioperative medication interruption. METHODS: This retrospective study included patients who underwent TURP between January 2020 and December 2024 at our tertiary referral center. Patients were divided into three groups according to their perioperative use of AP and AC medications. CONTROL GROUP: Patients who did not receive any AC or AP therapy. AP group: Patients receiving antiplatelet therapy. AC group: Patients treated with anticoagulants. None of the patients underwent TURP under continued AP or AC therapy. Perioperative and postoperative outcomes, including duration of irrigation, duration of catheterization, length of hospital stay, development of clot retention during hospitalization, need for postoperative blood transfusion, readmission due to hematuria within 30 days, and need for recatheterization or reoperation due to bleeding, were evaluated. A composite bleeding outcome was created to increase statistical power including postoperative blood transfusion, clot retention, and hematuria-related readmission. RESULTS: A total of 325 patients were included: 198 in the control group, 97 in the AP group, and 30 in the AC group. Overall comparisons showed significant differences in postoperative transfusion (p = 0.001) and hematuria-related readmission rates (p = 0.032) between three groups but post-hoc pairwise Fisher's exact tests with Bonferroni correction did not confirm statistical significance between specific pairs. There were no significant differences between the groups in other parameters. Multivariable logistic regression identified antiplatelet therapy as an independent predictor of hematuria-related readmission (OR:4.17, p = 0.010). CONCLUSION: AP therapy is independently associated with an increased risk of hematuria-related readmission even after perioperative interruption of therapy. Patients receiving antithrombotic therapy should be carefully monitored during the perioperative period, and clinicians should remain vigilant for potential bleeding-related complications.
Okumura Y, Amaya Y, Inamura S
… +13 more, Inamura M, Kaeriyama K, Okubo N, Shimada S, Kakitsuba T, Seo W, Tanaka N, Fukiage Y, Kabuto T, Tsutsumiuchi M, Seki M, Taga M, Terada N
OBJECTIVE: To evaluate the usability and accuracy of a newly developed automated bladder diary (BD) device, the Uro-diary Checker (UDC), in comparison with a conventional handwritten BD. METHODS: In this prospective, mul...OBJECTIVE: To evaluate the usability and accuracy of a newly developed automated bladder diary (BD) device, the Uro-diary Checker (UDC), in comparison with a conventional handwritten BD. METHODS: In this prospective, multi-institutional observational study, 40 patients with lower urinary tract symptoms (LUTS) were recruited between April 2023 and October 2024. Participants recorded their voiding patterns using a handwritten BD for 3 days and the UDC for the next 3 days. The UDC automatically recorded voiding time and volume when a urine cup was placed on the device, and the data were transferred via Bluetooth to a computer. The primary endpoint was usability, assessed using the System Usability Scale (SUS), a validated 10-item Likert-scale questionnaire. RESULTS: Of the 40 enrolled patients, 31 successfully completed records using both methods and were included in the final analysis. The mean patient age was 72.6 ± 9.8 years; 24 were male and 7 were female. The SUS score was significantly higher for the UDC (72.9 ± 19.3) than for the BD (60.6 ± 19.5; P < .01), exceeding the benchmark score of 68 and indicating good usability. UDC-recorded urine volumes were highly consistent with BD measurements for both 24-hour urine volume (r = 0.86, P < .01) and average voided volume (r = 0.77, P < .01). CONCLUSION: The UDC demonstrated significantly greater usability than the conventional BD while maintaining comparable accuracy for urine volume measurements, suggesting its potential to improve adherence and efficiency in LUTS evaluation.
OBJECTIVE: To evaluate long-term changes in uroflowmetry patterns from childhood to puberty after hypospadias repair and identify boys with abnormal urinary flow who may require surgery. MATERIALS AND METHODS: This retro...OBJECTIVE: To evaluate long-term changes in uroflowmetry patterns from childhood to puberty after hypospadias repair and identify boys with abnormal urinary flow who may require surgery. MATERIALS AND METHODS: This retrospective cohort included patients who underwent hypospadias repair with creation of a neourethra at a tertiary center between 2000 and 2006, with minimum follow-up of 12 years. Patients were grouped by hypospadias severity and assessed with uroflowmetry at prepubertal age and during puberty. Flow patterns were classified according to International Children's Continence Society criteria, and flow index was calculated to adjust maximum flow rate for voided volume. RESULTS: Forty-seven patients (20 distal, 27 proximal) were included. Prepubertal plateau-shaped flows occurred in 23 patients (48.9%). Among these, spontaneous improvement occurred in 15, surgery for symptomatic obstruction was required in 6 (26.1%), and plateau-shaped flow persisted without symptoms in 2. In patients with prepubertal plateau-shaped flow not requiring surgery, median maximum flow rate increased from 11.2 mL/s prepuberty to 21.4 mL/s during puberty (P < .001), with a corresponding rise in flow index. No significant differences in long-term uroflowmetry outcomes were observed between distal and proximal hypospadias. CONCLUSION: Most plateau-shaped flow patterns after hypospadias repair improve spontaneously during puberty, supporting conservative management in asymptomatic patients. Surgery should be reserved for boys with persistent abnormal flow and urinary symptoms.