Letter to Editor - Utility of genetic work-up for 46, XY patients with severe hypospadias

It was really difficult for us to understand the context of this article, which we believe is a combination of clinical observations of hypospadias and scientific data from genetic studies [ ]. The authors have included a very small number of hypospadias patients with heterogeneous anatomy, and simply classify them as “standard” and "severe" hypospadias. As per the published literature, the classification of these cases as standard, or cases with a small glans size, etc., lacks a conclusive scientific/anatomical basis. It is sobering to see that the term “standard hypospadias” is not present in human anatomical and surgical texts. The authors could have utilized the normal anatomical characteristics of penis for a better segregation of these cases. Moreover, in this study, the clinical findings of the patients were termed as “anatomical characteristics”. However, the authors seem to show a departure from the normal postnatal anatomical characteristics of penis, e.g., septum glandis and frenulum. The septum glandis is a well-documented fibrous median partition of the glans penis and the frenulum is its epithelial extension to the foreskin [ , , ]. It is unfortunate to see that many surgeons (including the senior author) have shown a consistent denial in accepting these normal postnatal anatomical characteristics published hundreds of years ago [ ].