C J Long1, D A Canning2. 1. Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA. Electronic address: longc3@email.chop.edu. 2. Division of Urology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 3rd Floor Wood Center, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Abstract
OBJECTIVE: Hypospadias surgery is a humbling art form. Although outcomes with distal hypospadias are favorable, recent publications have suggested that the complication rates are much higher than previously anticipated for proximal hypospadias. The present review examined the literature concerning proximal hypospadias, to explore some of the inadequacies and identify some of the reasons behind these shortfalls in the reported data. METHODS: A systematic review of the published literature was conducted using keywords relevant to proximal hypospadias and long-term outcomes. RESULTS: The literature for hypospadias was reviewed, and outcomes for distal vs proximal variants were compared. The quality of the literature for proximal hypospadias was examined, and the shortcomings that led to underreporting of the surgical outcomes were identified. Special focus was on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow-up. There was also a great deal of variability in the utilized techniques, and the literature was filled with small case series from single institutions. To enable scientific assessment of outcomes, it is proposed that the following be implemented: acceptance and incorporation of standardized phenotype assessment scores in the pre-operative period, objective intraoperative hypospadias characterization, and postoperative score assessment. CONCLUSIONS: Treatment of proximal hypospadias is much less successful than the distal variant. A specialty wide commitment to standardize the hypospadias language is required to make advancement in surgical outcomes. Boys need to be followed through puberty into adulthood, and honest reporting of outcomes must be discussed so that surgical techniques for this complicated disease process can be advanced.
OBJECTIVE:Hypospadias surgery is a humbling art form. Although outcomes with distal hypospadias are favorable, recent publications have suggested that the complication rates are much higher than previously anticipated for proximal hypospadias. The present review examined the literature concerning proximal hypospadias, to explore some of the inadequacies and identify some of the reasons behind these shortfalls in the reported data. METHODS: A systematic review of the published literature was conducted using keywords relevant to proximal hypospadias and long-term outcomes. RESULTS: The literature for hypospadias was reviewed, and outcomes for distal vs proximal variants were compared. The quality of the literature for proximal hypospadias was examined, and the shortcomings that led to underreporting of the surgical outcomes were identified. Special focus was on the lack of standardized documentation, the subsequent inability to objectify the severity of the phenotype, and the underestimation of complications due to lack of long-term follow-up. There was also a great deal of variability in the utilized techniques, and the literature was filled with small case series from single institutions. To enable scientific assessment of outcomes, it is proposed that the following be implemented: acceptance and incorporation of standardized phenotype assessment scores in the pre-operative period, objective intraoperative hypospadias characterization, and postoperative score assessment. CONCLUSIONS: Treatment of proximal hypospadias is much less successful than the distal variant. A specialty wide commitment to standardize the hypospadias language is required to make advancement in surgical outcomes. Boys need to be followed through puberty into adulthood, and honest reporting of outcomes must be discussed so that surgical techniques for this complicated disease process can be advanced.
Authors: Amanda F Saltzman; Alonso Carrasco; Alexandra Colvin; Jeffrey B Campbell; Vijaya M Vemulakonda; Duncan Wilcox Journal: World J Urol Date: 2018-05-31 Impact factor: 4.226
Authors: Christopher J Long; David I Chu; Robert W Tenney; Andrew R Morris; Dana A Weiss; Aseem R Shukla; Arun K Srinivasan; Stephen A Zderic; Thomas F Kolon; Douglas A Canning Journal: J Urol Date: 2016-11-10 Impact factor: 7.450
Authors: Patrick Pine Tanseco; Harkanwal Randhawa; Michael Erlano Chua; Udi Blankstein; Jin Kyu Kim; Melissa McGrath; Armando J Lorenzo; Luis H Braga Journal: Can Urol Assoc J Date: 2018-12-03 Impact factor: 1.862