East Montgomery Times

Hypospadias, a congenital malformation affecting up to 1 in 200 male births, has been the focus of a recent study led by Dr. Christopher J. Long at Children's Hospital of Philadelphia (CHOP). The research aimed to evaluate the impact of complex variants in patients with distal hypospadias on surgical outcomes. This study was supported by a $25,000 grant from the Center for Outcomes Research in Surgery (CORES).

Boys with hypospadias typically present with three main features: an incompletely formed foreskin, chordee (a bent or curved penis), and a urethral opening located lower on the penis. While some cases do not require surgery, many boys undergo procedures to optimize urinary and sexual function as well as cosmetic appearance.

Surgery for hypospadias can be difficult, particularly for those with complex anatomy. "These patients can experience a complication after surgery up to 40% of the time," said Dr. Long. He emphasized that success is most likely with the first surgery and highlighted efforts to adapt approaches based on individual patient needs.

The study identified patients with narrow penile heads or unfavorable urethral grooves, which negatively affect traditional repair techniques due to increased tension during closure. Complication rates for distal hypospadias surgeries range from 5-30%, but CHOP's rate ranges from 5-10%. However, more complex cases showed a complication rate of 20%.

Dr. Long described an alternative surgical approach where incising deeply within the back wall and placing a skin graft significantly reduced complications from 20% to 3%. This method creates more space for closing over the urethra, improving both appearance and urine flow.

To enhance outcomes at CHOP, an extensive database was created for assessing patient anatomy and surgical details in real-time rather than years later through manual chart reviews. "For this grant," explained Dr. Long, "we identified this higher-risk anatomy, compared two alternative surgical approaches," ultimately determining which improved outcomes most significantly.

Additionally, CHOP implemented a nudge tool within their electronic medical records system that alerts staff when high-risk anatomy is documented on a patient. This reinforces considering technical modifications that may lead to better results.

"This research project and the subsequent nudge tool have led to considerable benefits for our patients," noted Dr. Long while expressing anticipation for future discoveries related to these complex variants.