Hypospadias Outcome In The First 3 Years After Completing A Pediatric Urology Fellowship

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health
Article Date: 26 Jun 2008 - 8:00 PST

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UroToday.com - A study by Dr. Dominic Frimberger, et al. from Oklahoma City, Oklahoma evaluated the outcome of hypospadias surgery performed by 2 academic pediatric urologists in their first three years of practice after completing a two year fellowship. This was a retrospective chart review of all patients who underwent a hypospadias reconstruction by two separate surgeons between July 2004 and August 2007. The two surgeons had completed a 2-year Pediatric Urology fellowship at two different institutions. Level of hypospadias, patient age, type of repair and follow up as well as complications were recorded.

The study showed that a total of 187 patients underwent hypospadias surgery. There were no significant differences in the numbers and complications between the two surgeons. Distal hypospadias, which was defined as both midshaft and distal, was found in 149 patients. Proximal was found in 29 patients, while penoscrotal or perineal was found in 9 patients and required a two-stage repair. All of the distal hypospadias repairs were performed either with a dorsal plate incision with tubularization in 112 patients or with a meatal advancement and glanuloplasty in 37 patients. All the proximal hypospadias were repaired utilizing a dorsal plate incision with tubularization. All the patients were seen after 2 weeks, 6 months and 12 months postoperatively. Fistulae occurred in 10 patients for an overall fistula rate of 5.3%. The fistulas occurred in 3 patients who were in the distal hypospadias category, 4 patients in the proximal and 3 patients in the 2-staged repairs. Meatal stenosis occurred in 3 distal repairs and 1 two-staged repair. There was a diverticulum in one proximal repair. There were no complications seen with their meatal advancement and glanuloplasty repairs. The majority of their complications were successfully repaired with one single operation.

The group concluded that modern hypospadias surgical techniques can be transferred on to a new generation of specially trained pediatric urologists. They felt that current fellowship training allows distal hypospadias repairs to be performed with the minimal fistula rate of only 2.8%. The proximal hypospadias remain more challenging with their complication rates of 13.8% for one-stage and 33.3% for two-stage repairs.

Better outcomes for hypospadias surgery are seen with a higher volume of cases. The high volume that ones sees during fellowship and then translated into their first years of practice can be maintained as long as a high number of cases per year are maintained in the practice. It would allow one to keep a high skill level as well as help redefine techniques to give our patients a better outcome. I truly do not believe we have figured it all out when it comes to hypospadias surgery. Fluid dynamics differ between a distensible tube and a rigid tube. Finding the happy medium between the normal distensible urethra and the more rigid hypospadias repair will be the true challenge and might end up being the answer to some of our complications.

Dominic Frimberger, Jeffrey Campbell, Bradley P. Kropp
Journal of Pediatric Urology
DOI: 10.1016/j.jpurol.2008.01.203

Reported by UroToday.com Medical Editor Pasquale Casale, MD

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