Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Justine R Yamashiro¹, J Christopher Austin², Luis H Braga³, Kai-Wen Chuang⁴, Carol A Davis-Dao⁵, Sarah Hecht⁶, Sarah A Holzman⁷, Antoine E Khoury⁸, Eric A Kurzrock⁹, Steven E Lerman¹⁰, Melissa McGrath¹¹, Paul A Merguerian¹², Amanda F Saltzman¹³, Anthony J Schaeffer¹⁴, Casey Seideman¹⁵, Jennifer S Singer¹⁶, Peter Wang¹⁷, Elias J Wehbi¹⁸, Hsi-Yang Wu¹⁹, Renea M Sturm²⁰

Affiliations

¹ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: jyamashiro7@gmail.com.
² Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: austin@ohsu.edu.
³ McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Electronic address: braga@mcmaster.ca.
⁴ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: kaiwenc2@hs.uci.edu.
⁵ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: carol.davis.dao@choc.org.
⁶ Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: hecht@ohsu.edu.
⁷ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: saholzma@hs.uci.edu.
⁸ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: aekhoury@hs.uci.edu.
⁹ University of California Davis, 4860 Y Street, Suite 2200, Sacramento, CA, 95817, USA. Electronic address: eakurzrock@ucdavis.edu.
¹⁰ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: stevelerman@mednet.ucla.edu.
¹¹ McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Electronic address: mcgram2@mcmaster.ca.
¹² University of Washington, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA. Electronic address: paul.merguerian@seattlechildrens.org.
¹³ University of Kentucky, 800 Rose Street, MS 237, Lexington, KY, 40536, USA. Electronic address: afsaltzman@gmail.com.
¹⁴ University of Utah, 100 N Mario Capecchi Drive, Suite 3550, Salt Lake City, UT, 84113, USA. Electronic address: anthony.schaeffer@hsc.utah.edu.
¹⁵ Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: seideman@ohsu.edu.
¹⁶ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: jsinger@mednet.ucla.edu.
¹⁷ LHSC-Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 5A5, Canada. Electronic address: peter.wang@lhsc.on.ca.
¹⁸ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: ewehbi@hs.uci.edu.
¹⁹ Brown University, 593 Eddy Street, Suites 185 & 190, Providence, RI, 02903, USA. Electronic address: hwu6@lifespan.org.
²⁰ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: rsturm@mednet.ucla.edu.

PMID: 36775718
PMCID: PMC10686787
DOI: 10.1016/j.jpurol.2022.12.001

Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Justine R Yamashiro et al. J Pediatr Urol. 2023 Jun.

. 2023 Jun;19(3):277-283.

doi: 10.1016/j.jpurol.2022.12.001. Epub 2023 Jan 11.

Authors

Affiliations

¹ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: jyamashiro7@gmail.com.
² Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: austin@ohsu.edu.
³ McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Electronic address: braga@mcmaster.ca.
⁴ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: kaiwenc2@hs.uci.edu.
⁵ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: carol.davis.dao@choc.org.
⁶ Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: hecht@ohsu.edu.
⁷ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: saholzma@hs.uci.edu.
⁸ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: aekhoury@hs.uci.edu.
⁹ University of California Davis, 4860 Y Street, Suite 2200, Sacramento, CA, 95817, USA. Electronic address: eakurzrock@ucdavis.edu.
¹⁰ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: stevelerman@mednet.ucla.edu.
¹¹ McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. Electronic address: mcgram2@mcmaster.ca.
¹² University of Washington, 4800 Sand Point Way NE, OA.9.220, Seattle, WA, 98105, USA. Electronic address: paul.merguerian@seattlechildrens.org.
¹³ University of Kentucky, 800 Rose Street, MS 237, Lexington, KY, 40536, USA. Electronic address: afsaltzman@gmail.com.
¹⁴ University of Utah, 100 N Mario Capecchi Drive, Suite 3550, Salt Lake City, UT, 84113, USA. Electronic address: anthony.schaeffer@hsc.utah.edu.
¹⁵ Oregon Health & Science University, 700 S.W. Campus Drive, Portland, Oregon, USA 97239, 875 Oak Street S.E., Salem, OR, 97301, USA. Electronic address: seideman@ohsu.edu.
¹⁶ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: jsinger@mednet.ucla.edu.
¹⁷ LHSC-Victoria Hospital, 800 Commissioners Road East, London, Ontario, N6A 5A5, Canada. Electronic address: peter.wang@lhsc.on.ca.
¹⁸ Children's Hospital of Orange County and University of California Irvine, 101 the City Dr S Pavilion 3, Orange, CA, 92686, USA. Electronic address: ewehbi@hs.uci.edu.
¹⁹ Brown University, 593 Eddy Street, Suites 185 & 190, Providence, RI, 02903, USA. Electronic address: hwu6@lifespan.org.
²⁰ University of California Los Angeles, 200 Medical Plaza, Suite 170, Los Angeles, CA, 90095, USA. Electronic address: rsturm@mednet.ucla.edu.

PMID: 36775718
PMCID: PMC10686787
DOI: 10.1016/j.jpurol.2022.12.001

Abstract

Background: Although hypospadias outcomes studies typically report a level or type of repair performed, these studies often lack applicability to each surgical practice due to technical variability that is not fully delineated. An example is the tubularized incised plate (TIP) urethroplasty procedure, for which modifications have been associated with significantly decreased complication rates in single center series. However, many studies fail to report specificity in techniques utilized, thereby limiting comparison between series.

Objective: With the goal of developing a surgical atlas of hypospadias repair techniques, this study examined 1) current techniques used by surgeons in our network for recording operative notes and 2) operative technical details by surgeon for two common procedures, tubularized incised plate (TIP) distal and proximal hypospadias repairs across a multi-institutional surgical network.

Study design: A two-part study was completed. First, a survey was distributed to the network to assess surgeon volume and methods of recording hypospadias repair operative notes. Subsequently, an operative template or a representative de-identified operative note describing a TIP and/or proximal repair with urethroplasty was obtained from participating surgeons. Each was analyzed by at least two individuals for natural language that signified specified portions of the procedure. Procedural details from each note were tabulated and confirmed with each surgeon, clarifying that the recorded findings reflected their current practice techniques and instrumentation.

Results: Twenty-five surgeons from 12 institutions completed the survey. The number of primary distal hypospadias repairs performed per surgeon in the past year ranged from 1-10 to >50, with 40% performing 1-20. Primary proximal hypospadias repairs performed in the past year ranged from 1-30, with 60% performing 1-10. 96% of surgeons maintain operative notes within an electronic health record. Of these, 66.7% edited a template as their primary method of note entry; 76.5% of these surgeons reported that the template captures their operative techniques very or moderately well. Operative notes or templates from 16 surgeons at 10 institutions were analyzed. In 7 proximal and 14 distal repairs, parameters for chordee correction, urethroplasty suture selection and technique, tissue utilized, and catheter selection varied widely across surgeons.

Conclusion: Wide variability in technical surgical details of categorically similar hypospadias repairs was demonstrated across a large surgical network. Surgeon-specific modifications of commonly described procedures are common, and further evaluation of short- and long-term outcomes accounting for these technical variations is needed to determine their relative influence.

Keywords: Catheters; Hypospadias; Reconstructive surgical procedures; Sutures; Urethra.

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Conflict of interest statement

Conflicts of interest All authors have confirmed that there are no conflict of interests. This includes any financial and personal relationships with people or organizations that could inappropriately influence (bias) this work.

Comment in

Surgical process variables for the classification of hypospadias.
Özbey H. Özbey H. J Pediatr Urol. 2023 Jun;19(3):284-285. doi: 10.1016/j.jpurol.2023.01.020. Epub 2023 Feb 23. J Pediatr Urol. 2023. PMID: 36890024 No abstract available.
Response to letter to the Editor re: Variability in surgical practices and instrumentation for hypospadias repair.
Sturm R; Western Pediatric Urology Consortium. Sturm R, et al. J Pediatr Urol. 2023 Jun;19(3):286-287. doi: 10.1016/j.jpurol.2023.02.007. Epub 2023 Feb 26. J Pediatr Urol. 2023. PMID: 36934032 No abstract available.

References

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1. Jayanthi VR, The modified Koyanagi hypospadias repair for the one-stage repair of proximal hypospadias. Indian J Urol, 2008. 24(2): p. 206–9. - PMC - PubMed
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Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Affiliations

Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous