Cook A et al. (2005) A multicenter evaluation of technical preferences for primary hypospadias repair. J Urol 174: 2354–2357

Numerous techniques exist for the surgical repair of hypospadias, with considerable controversy about which is the optimal method, yet little has been published regarding which techniques are used most often by practicing clinicians. Now Cook and colleagues in Canada have conducted a survey to determine which surgical techniques are preferred by an international cohort of pediatric urologists.

The investigators developed a questionnaire presenting five hypothetical hypospadias cases including distal, midshaft, and proximal defects associated with varying degrees of CHORDEE. Participants were asked to indicate which repair technique they would use in each scenario and what factors influenced this decision. Relevant demographic data was also requested. The questionnaire was sent to 121 pediatric urologists, of which 101 responded.

The majority of respondents preferred the tubularized incised urethral plate (TIP) technique for the repair of both distal and midshaft hypospadias, whereas a variety of techniques were favored for proximal defects and chordee correction. The most important factor influencing choice of technique was personal experience.

Statistical analysis using Spearman's rank correlation coefficient showed that choice of repair technique was not influenced by the number of hypospadias repairs performed monthly, the type of practice (academic versus private), or the number of years in practice.

The authors conclude that prospective, comparative trials are needed to determine the optimal surgical technique for hypospadias repair.