Current trends in the management of hypospadias: the Ibero-American experience
- Urology & Nephrology Open Access Journal
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Celeste Alston,1
Ana Bernal,2
Beliza Bernal,3
Luciana Lerendegui,4
Santiago Vallasciani,5
Juan Carlos Prieto,6
Marcos Young,7
Miguel
Castellan4
Abstract
Introduction: Hypospadias management has seen various trends over the years, likely due
to the diverse clinical presentations and evolving surgical techniques. However, there is a
lack of consensus among pediatric urologists on many aspects of hypospadias management.
To address this, our research aims to survey specialists and establish a consensus on
hypospadias management.
Methodology: In July 2021, a cross-sectional study was conducted using a Survey Monkey
questionnaire consisting of 23 questions. The survey aimed to gather information about
the generalities and management preferences of distal and proximal hypospadias from
specialists belonging to the Ibero-American Society of Pediatric Urology (SIUP). The
data collected was categorized into subgroups based on surgical techniques, perioperative
preferences, and complications.
Results: Most hypospadias surgeries are performed between 13-18 months. Penile curvature
is evaluated with artificial erection and visual inspection. The Nesbit technique (36.1%) and
ventral corportomies (26.9%) corrections are more common, while grafts corporoplasties
are used less frequently (10.2%) for correction. For urethroplasty, the surveyed group prefers
using a running suture or a combination of continuous and interrupted stitches (49.1% and
24.3%, respectively). The use of Polydioxanone 6-0 in a double-layer suture group yielded
a higher response rate. The use of prophylactic antibiotics and their maintenance when the
catheter is in place was also favored by most surgeons.
Discussion: When repairing hypospadias, the surgeon must consider factors such as the
quality of the urethral plate, the presence of penile curvature, and the location of the urethral
opening. This study highlights the different strategies and technical preferences used for
hypospadias repair by a group of specialists from different countries.
Conclusion: The survey describes current trends in hypospadias management. Two-stage
repair is commonly used for proximal hypospadias, while TIP repair is the most used
technique for distal hypospadias. The most common complication is the development of
an urethrocutaneous fistula.
Keywords
hypospadias, two stage repair, TIP, survey
