Hypospadias-associated penile curvature assessment and management: A global survey of current practice

Tariq O Abbas; Michael Sennert; Sibel Tiryaki; Nicolas Fernandez; Mohamed Fawzy; Ahmed Hadidi

doi:10.1016/j.jpurol.2024.02.006

Hypospadias-associated penile curvature assessment and management: A global survey of current practice

J Pediatr Urol. 2024 Feb 13:S1477-5131(24)00086-X. doi: 10.1016/j.jpurol.2024.02.006. Online ahead of print.

Authors

Tariq O Abbas¹, Michael Sennert², Sibel Tiryaki³, Nicolas Fernandez⁴, Mohamed Fawzy⁵, Ahmed Hadidi⁵

Affiliations

¹ Pediatric Urology Section, Sidra Medicine, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine Qatar, Doha, Qatar. Electronic address: Tariq2c@hotmail.com.
² Department of Pediatric Surgery, University Clinic, Hamburg, Germany.
³ Ege University, Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, Turkey.
⁴ Division of Pediatric Urology Seattle Children's Hospital, Department of Urology University of Washington, United States.
⁵ Hypospadias Clinic, Department of Pediatric Surgery, Emma and Offenbach Hospitals, Offenbach, Germany.

PMID: 38418260
DOI: 10.1016/j.jpurol.2024.02.006

Abstract

Introduction: Our goal was to assess how surgical management of hypospadias-associated penile curvature (HAPC) varies across continents, focusing on factors that influence assessment and decision-making.

Methods: Members of the European Society of Pediatric Urology (ESPU), Society of Pediatric Urology (SPU), and Hypospadias International Society (HIS) participated in an anonymous, 34-question online survey addressing pre-, intra-, and postoperative elements of HAPC evaluation and management. A selection of intraoperative photos were included in the survey to investigate the prevailing surgical approaches and identify management patterns.

Results: Out of the 267 participants, 38.4% of them are located in Europe. Visual estimation was the predominant approach for evaluating HAPC, although being regarded as the least dependable compared to other techniques. Surgeons who performed more than 40 cases per year were more inclined to use goniometers and had varying degrees of HAPC that were considered acceptable without requiring any correction (P < .001). Out of 58% of respondents, a significant number reported regular utilization of artificial erection tests for all categories of hypospadias. Surgeons with fewer than 10 years of expertise commonly utilized erection test as part of their regular practice. A tourniquet was employed to maintain sufficient intra-corporeal pressure, by134 (50%). 116 participants (43%) inject Saline through the corpora cavernosa through the glans, while 150 (56%) administer saline from the lateral aspect. Moreover, the decision-making process differed based on the intraoperative picture scenarios of mild to moderate penile curvature during erection testing. Contrary to temperatures ranging from 25^o to 35^o, decision-making in cases with less severe degrees of HAPC was uncomplicated.

Conclusion: This survey reveals a wide range of surgical practice patterns in the assessment and management of HAPC. To our knowledge, this global survey of HAPC practice is the largest to date and could aid in developing new guidelines in pediatric urology. These findings may also provide a foundation for future prospective multinational studies.

Keywords: Hypospadias; Management; Measurement; Penile curvature; Survey.