Articles

Platinum Priority – Pediatric Urology
Editorial by Antonella Giannantoni on pp. 1190–1191 of this issue

Trends in Hypospadias Surgery: Results of a Worldwide Survey

By: Alexander Springerlowast , Wilfried Krois and Ernst Horcher

European Urology, Volume 60 Issue 1, December 2011, Pages 1184-1189

Published online: 01 December 2011

Keywords: Chordee, Hypospadias, Questionnaire, Survey, TIP, Two stage repair

Abstract Full Text Full Text PDF (396 KB)

Abstract

Background

Hypospadias is a challenging field of urogenital reconstructive surgery, with different techniques currently being used.

Objective

Evaluate international trends in hypospadias surgery.

Design, setting, and participants

Paediatric urologists, paediatric surgeons, urologists, and plastic surgeons worldwide were invited to participate an anonymous online questionnaire (http://www.hypospadias-center.info).

Measurements

General epidemiologic data, preferred technique in the correction of hypospadias, and preferred technique in the correction of penile curvature were gathered.

Results and limitations

Three hundred seventy-seven participants from 68 countries returned completed questionnaires. In distal hypospadias (subcoronal to midshaft), the tubularised incised plate (TIP) repair is preferred by 52.9–71.0% of the participants. Meatal advancement and glanuloplasty (MAGPI) is still a preferred method in glandular hypospadias. In the repair of proximal hypospadias, the two-stage repair is preferred by 43.3–76.6%. TIP repair in proximal hypospadias is used by 0.9–16.7%. Onlay flaps and tubes are used by 11.3–29.5% of the study group. Simple plication and Nesbit's procedure are the techniques of choice in curvature up to 30°; urethral division and ventral incision of the tunica albuginea with grafting is performed by about 20% of the participants in severe chordee. The frequency of hypospadias repairs does not influence the choice of technique.

Conclusions

In this study, we identified current international trends in the management of hypospadias. In distal hypospadias, the TIP repair is the preferred technique. In proximal hypospadias, the two-stage repair is most commonly used. A variety of techniques are used for chordee correction. This study contains data on the basis of personal experience. However, future research must focus on prospective controlled trials.

Take Home Message

An international survey (377 surgeons) showed that in distal hypospadias, the tubularised incised plate procedure is first-line therapy, whereas in proximal hypospadias, the two-stage procedure is preferred. A variety of techniques are used for chordee correction.

Keywords: Chordee, Hypospadias, Questionnaire, Survey, TIP, Two stage repair.

Footnotes

Department of Paediatric Surgery, Medical University of Vienna, Austria

lowast Corresponding author. Department of Paediatric Urology, Leeds Teaching Hospitals, Leeds, UK. Tel. +44 7412 690107.

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