Hypospadias Research Update

Over the past decade, we have seen many advances in hypospadias research within the Division of Urology at Children’s Hospital of Philadelphia. In the early and mid-2010s, we fundamentally transformed how we collected data on hypospadias patients.

We were able to leverage the electronic medical record and create standardized preoperative, intraoperative and postoperative documentation to be used by all 13 surgeons at our institution. In doing so, we became one of the first institutions to standardize clinical documentation and collect granular data on penile biometrics, operative surgical details, and postoperative outcomes for all patients, which has allowed us to evaluate our outcomes and advance treatment strategies.

Now, almost 10 years later, we are reaping the rewards of seamlessly integrating research data collection into the clinical setting. We highlight two of our recent projects below.

Within the hypospadias literature, the use of androgen stimulation prior to surgery is often debated. This past year, we sought to examine our own outcomes with androgen stimulation prior to hypospadias repair. Our study results were presented at the American Urologic Association (AUA) conference in Chicago and published in the Journal of Urology.

Our study analyzed distal hypospadias patients undergoing primary hypospadias repair with urethroplasty and compared outcomes of those who did versus did not receive testosterone. Our comprehensive hypospadias databank allowed us to easily stratify and analyze data with minimal need for manual chart review — expediting the research process.

On multivariable logistic regression we found that, after accounting for age, urethroplasty length, and glans width, patients who received testosterone had significantly less postoperative complications compared to those that did not. This was the largest retrospective study ever published on androgen stimulation in hypospadias patients and was a valuable addition to the hypospadias literature.

We also recently investigated what impact social determinants of health have on long-term outcomes after distal hypospadias repair. The study results were selected for a podium presentation at the upcoming Society of Pediatric Urology Fall Congress in Houston, Texas. In this study, we used the Childhood Opportunity Index (COI) as a measure of the quality of resources present in a community (1 – Low; 5 – High) for a child to develop in a healthy way and determined if any correlation was present between lower COI scores and increased incidence of complications.  

After analyzing almost 1,000 hypospadias patients, we found no association between hypospadias complications and lower COI scores, however we did find that those with low COI scores had a significantly higher risk of being lost to follow-up. With these results, we hope to better deliver equitable care to all patients, by identifying barriers to follow-up in patients with lower COI scores and targeting these at-risk cohorts with referrals to appropriate services that can facilitate improved post operative follow-up.

As a Division, we are excited with the strides we have made in our hypospadias research in recent years and remain committed to further refining our own data collection methods, incorporating novel outcome measures, and collaborating with other institutions in order to deliver the best care possible to our patients. As modern medicine continues to evolve, we know we must also adapt to the changing landscape to remain at the forefront of healthcare across the world.