The UK primary hypospadias surgery audit 2006–2007

doi:10.1016/j.bjps.2009.08.008

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 63, Issue 8, August 2010, Pages 1349-1352

https://doi.org/10.1016/j.bjps.2009.08.008 Get rights and content

Summary

Aim

To find out what primary hypospadias surgery is being done in the United Kingdom and at what ages patients have surgery.

Methods

On behalf of the British Associations of Paediatric Urologists, Paediatric Surgeons and Plastic, Reconstructive and Aesthetic Surgeons, paediatric surgeons/urologists, plastic surgeons and urologists were asked to record prospectively their data for 12 months, October 2006–September 2007.

Results

There were 50 replies (response rate 50%, 79% of plastic surgeons and 40% of paediatric surgeons/urologists). Most patients had distal hypospadias. The total numbers of operations were 814 (paediatric surgeons/urologists), 436 (plastic surgeons) and 5 (one urologist). More than 20 operations a year were performed by 79% of paediatric surgeons/urologists and 35% of plastic surgeons. Both groups used a similar range of single-stage and two-stage operations. Patients' ages at surgery were less than two years for 68% of paediatric surgeons/urologists and two to four years for 60% of plastic surgeons.

Conclusions

In the UK most primary hypospadias surgery in children is performed by paediatric surgeons/urologists and plastic surgeons. Both groups of surgeons use a range of procedures. Many plastic surgeons are low volume operators. Most plastic surgeons operate on children two or more years old. Plastic surgeons should change their hypospadias service. All hypospadias surgeons should contribute to future prospective outcome studies of hypospadias surgery.

Section snippets

Materials and methods

A one-page proforma for data was drafted and then made shorter and simpler to complete with the help of paediatric urology colleagues, in particular Stuart O'Toole, at that time the Secretary of BAPU.

On the proforma surgeons had to give numbers of the types of hypospadias treated, e.g glanular, subcoronal, etc., the types and numbers of primary hypospadias operations, e.g. meatotomy, Snodgrass TIP, Ist stage Bracka, 2nd stage Bracka, and the ages of the patients at primary surgery (less than

Results

There were 50 replies from paediatric surgeons/urologists (n = 24) and plastic surgeons (n = 26) and one from a urologist (an overall response of 53%, 79% of plastic surgeons and 40% of paediatric surgeons).

Most of the patients treated by the paediatric surgeons, the plastic surgeons and the urologist had some form of distal hypospadias.

The paediatric surgeons reported nearly twice as many operations (n = 814) as the plastic surgeons (n = 436). The urologist reported five operations.

There was also a

Discussion

This prospective audit shows the extent and variety of primary hypospadias surgery in the UK in 2006–2007.

The limitations and weaknesses of the audit are obvious. For example, only surgeons on the UK Register of Hypospadias Surgeons were asked to participate. It is possible that there are other surgeons not on the register who carry out primary hypospadias surgery, for example in the private sector outside the UK National Health Service. In addition, only 53% of registered surgeons took part in

The future

Low volume operators and those who routinely carry out primary hypospadias surgery in children after the age of two years should change their practice.

To help surgeons to make informed choices about the types of operations to use, prospective outcome studies are needed to provide more information.

In the UK, there is concern about the number of surgeons trained to carry out paediatric surgery and the future provision of paediatric surgery.⁹ All specialities who carry out hypospadias surgery

Acknowledgement

On behalf of BAPU, BAPS and BAPRAS I wish to thank all those who took part in this audit.

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Cited by (7)

Medium to long term results following single stage Snodgrass hypospadias repair
2013, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
The tubularised incised plate technique, as a one-stage procedure for distal hypospadias, was initially described by Orkiszewski4 as a salvage procedure in 1987 and popularized by Snodgrass in 1994.5 In the UK primary hypospadias surgery audit 2006–7, it was found to be the most common procedure performed for distal hypospadias repair.2 It involves tubularisation of the dorsally incised urethral plate without the need for skin flaps or grafts.
The Snodgrass technique for primary hypospadias repair was described in 1994 and involves dorsal incision and tubularisation of the urethral plate distal to the meatus. While the advantages of good short-term outcome and good cosmesis have been reported, there is little data on long-term results in patients who have undergone a Snodgrass repair as a primary procedure for hypospadias. Our aim is to retrospectively review our medium to long-term results of primary tubularised incised-plate urethroplasty for hypospadias repair over a two-year period with up to eight-year follow-up.
We conducted a case note review of 74 patients who had undergone single-stage Snodgrass hypospadias repair, performed by a single surgeon (AB), from April 2000 to January 2003.
The mean documented follow up was 56 months (3–103 months). The mean age of patients at time of surgery was three and a half years. 95% (70) of patients had a distal (glanular, coronal, sub-coronal, distal shaft) meatus and 5% (4) had a proximal (mid-shaft) meatus. The overall complication rate was 7% (5). Two patients developed fistulae, which was noted and repaired at six months post-op with no further surgical intervention required. One patient underwent an EUA and meatal advancement glansplasty at 6 months for mild glanular dehiscence. Two further patients required EUA and dilatation procedures at two and three years respectively, both for mild meatal stenosis. Again, no further intervention was required. From a cosmetic perspective, two patients were noted to have some residual bulkiness of the skin around the corona and a further two patients were noted to have a small meatus, but with no functional symptoms.
Our study has shown a low long-term complication rate in patients undergoing Snodgrass repair as a primary procedure for distal and midshaft hypospadias repair. This supports the results of earlier studies that have shown good functional and cosmetic outcome in the short-term for this procedure which persists into the medium/long term.
Trends in hypospadias surgery: Results of a worldwide survey
2011, European Urology
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Others have taken >20 operations per year as a criterion for a high-volume surgeon. However, what exactly constitutes a high-volume operator is a matter of discussion [9]. No prospective trials so far have defined a clear cut-off.
Hypospadias is a challenging field of urogenital reconstructive surgery, with different techniques currently being used.
Evaluate international trends in hypospadias surgery.
Paediatric urologists, paediatric surgeons, urologists, and plastic surgeons worldwide were invited to participate an anonymous online questionnaire (http://www.hypospadias-center.info).
General epidemiologic data, preferred technique in the correction of hypospadias, and preferred technique in the correction of penile curvature were gathered.
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.
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.
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2018, Urology Annals
Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes
2016, Indian Journal of Urology
Timing of hypospadias repair in patients with disorders of sex development
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^☆: Presented at the International Meeting on Hypospadias Surgery, Coventry, UK, May 2009.

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The UK primary hypospadias surgery audit 2006–2007☆

Summary

Aim

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

The future

Acknowledgement

J Urol

J Plast Reconstr Aesthet Surg

J Urol

Trends in surgical repair of hypospadias in England between 1997 and 2004

BJU Int