McMaster Pediatric Research Collaborative
International hypospadias practice pattern survey
Melissa McGrath1,2, Ahmed Hadidi2, Christopher Long2, Mark Zaontz2, Tiago Rosito2, Antonio Macedo2, Grahame Smith 2, Ibrahim Ulman2, Alex Springer 2, Moneer Hanna2, Luis H. Braga1,2.
1Surgery, McMaster University , Hamilton , ON, Canada; 2Hypospadias International Society , HIS, Frankfurt, Germany
Introduction: A variety of surgical techniques and postoperative care aspects exist for hypospadias (HS) repair. Currently, evidence based guidelines are lacking, resulting in a diverse clinical practice. We sought to inquiry members from 2 international groups, aiming to explore current practice patterns amongst hypospadiologists.
Methods: An online survey was distributed using REDCapâ to members of the Hypospadias International Society(HIS)and Brazilian School of Pediatric Urology(BSPU)regarding hypospadias repair patterns(pre, intra and post operatively). To ensure face and content validity, the survey was developed by experts and piloted locally. Anonymized responses were analyzed.
Results: Response rate was 75%(285/380), with 204(73%) respondents working in academic centers. The majority (169)60% performed <50 HS repairs/year, with 73% doing a mean of 16±21 proximal cases/year. Caudal blocks are still used by 198(72%) respondents, while testosterone stimulation is given selectively by 44%. Most (67%) would repair glanular HS, using MAGPI by 52%, even if parents did not want a circumcision(58%). TIP was the technique of choice for distal HS(76%). Staged repair was the technique of choice for, proximal HS with VC<30o (150-36%) and for those with VC>30o (213-80%). Most respondents (168-61%) measured VC by eyeballing. VC<30o post degloving was managed with DP by 58% of participants. 58% and 64% of respondents divide the urethral plate when the VC=30-70o and for >70o, respectively. In proximal/scrotal/perineal HS, 152(54%) believe the meatus does not need to be brought to tip of the glans. For a TIP repair breakdown, half would do a staged repair. Almost all respondents (91%) used post-op antibiotics and 62% followed patients past puberty.
Conclusions: Over 50% of respondents agreed in most categories regarding HS repair suggesting that multi-centre collaboration is more attainable than previously thought. Caudal block, dorsal plication and testosterone stimulation are still being widely used despite conflicting evidence. Severity of VC dictates procedure choice. Despite hypospadiology being perceived as an art, evidence based practice is possible, according to this survey’s results.