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Timing of hypospadias repair in patients with disorders of sex development.

What little data exist as to the optimal timing of hypospadias reconstruction is based on retrospective studies and expert opinion. No data exist as to the optimum timing of hypospadias reconstruction in the extremely small subset of patients with severe hypospadias that merits a disorder of sex development (DSD) diagnoses. Until such data exist, it seems prudent to continue to advocate for early and accurate diagnosis for patients with severe hypospadias to determine if they should be classified as a DSD. At that time, based on expert opinion, we would advocate early reconstructive hypospadias surgery as is presently done between 6 and 18 months of age. If and when evidence-based data refutes this early approach, new guidelines should be considered.