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available at http://www.ncbi.nlm.nih.gov/pubmed/28676152 Editorial Comment: The authors culled patients from a larger study to identify 51 boys who underwent repair of 57 hypospadias complications that occurred following primary hypospadias repair. Of these patients 18 (35%) had complications that presented late, defined as after 1 year. Complications presenting late were more likely to occur in patients who had undergone repair of distal or mid shaft vs proximal hypospadias and were more likely to be minor in nature, eg fistula rather than dehiscence or diverticulum. Patients with late complications were also more likely to have been instructed to return “as needed” rather than at a set interval. Complications following hypospadias repair can appear late. To avoid redo surgery at older ages, we need to be sure to provide a structured interval for reevaluation, even in boys who undergo distal repair. Douglas A. Canning, MD Re: Emerging Role of Preputial Vascular Pattern and Postoperative Microvessel Density in Cases of Proximal Hypospadias: A Pilot Study V. Narang, A. Sen and M. Bhardwaj Departments of Pediatric Surgery and Pathology, Dr. Ram Manohar Lohia Hospital, and Post Graduate Institute of Medical Education and Research, New Delhi, India Indian J Pathol Microbiol 2017; 60: 521e523. doi: 10.4103/IJPM.IJPM_792_16 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29323065available at http://www.ncbi.nlm.nih.gov/pubmed/29323065 Editorial Comment: This team studied 33 boys with proximal hypospadias who underwent repair. After degloving the authors transilluminated and assessed the vascular pattern of the prepuce. They predominantly performed single stage repairs using a tubularized incised plate technique with or without an inlay graft or island onlay repair. The preputial vascular pattern was classified as type 1 if there was a single predominant vessel, type 2 if there were 2 predominant vessels, and type 3 if there were 2 predominant vessels and collateralization. Type 4 was a reticular pattern where the authors could not identify a predominant vessel. The team then biopsied the prepuce to determine microvessel density. Patients with a reticular pattern did not undergo a single stage repair, but correction of chordee only and a planned second stage repair. Of patients who underwent a single stage repair complications were more common in those with vascular pattern type 1, where there was only a single vessel without collateralization. Low microvascular density also correlated with a statistically higher complication rate. We are always looking for ways to predict success or failure following hypospadias repair. Vascular pattern recognition may be a new tool. If we can get the data intraoperatively, microvessel density assessment may give us another parameter to measure, particularly if the child is a candidate for single stage repair. Douglas A. Canning, MD 430 PEDIATRIC UROLOGY Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.