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Pediatric urologists’ confidence and accuracy in estimating penile curvature

Published:November 16, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.11.004

      Summary

      Background

      Assessment and management of congenital penile curvature (PC) can be variable. Methods for correction of PC usually are dependent on degree of PC which is reliant on how degree is assessed. We sought to assess the confidence and accuracy of measuring PC and hence management using case-based examples.

      Methods

      A survey was emailed to members of the Societies for Pediatric Urology. Demographic information, management strategies for PC, and self-reported confidence in measuring PC were assessed. A Likert scale measured self-confidence. Case scenarios were used to assess ability to measure PC and methods of correction. The cases consisted of three computer-generated penis model images with arc-type ventral curvature and one image of lateral curvature in an infant.

      Results

      The response rate was 30% (108/355). The mean confidence score was 3.6 ± 0.8 (3-fairly confident; 4-very confident). In clinic, 89% of urologists used eyeball estimates to assess PC; 5% used both eyeball and goniometer. In the operating room, 71% used eyeball estimates, 8% used goniometer, and 16% used both. If sole decision-maker, urologists recommend surgical correction of PC over observation at median 30° (IQR 21–30°). At a median of 45°, there was a shift in corrective surgical preference from dorsal plication (DP) (IQR 30–54°) to ventral lengthening (IQR 34–60°).
      Urologists underestimated PC degree for all cases (summary table). For all cases, there was no association between years in practice or confidence level on estimated PC degree. In case 1, only 24% of urologists would correct a mean estimate of 23° PC; those who would correct had a higher mean PC estimate vs those who would not (28° vs 21°, p < 0.001). Case 2 and 4 had similar estimations and correction methods. In case 2, those who chose VL had a higher mean PC estimate vs those who did not (43° vs 37°, p < 0.01), but no estimate difference was seen for DP (p = 0.52). In case 4 with lateral PC, those who chose DP had a higher mean PC estimate vs those who did not (41° vs 33°, p = 0.049). Yet in case 3, there was no difference in PC estimate in urologists who chose VL vs not (57° vs 53°, p = 0.16).

      Conclusions

      Summary TableCase-based penile curvature provider answers.
      Case Degree Mean Degree Estimation ± Standard Deviation Surgical Correction? N (%) Method of Correction % of Respondents
      Multiple answers allowed.
      1 30 23.2 ± 7.01 Yes 24 (23.5) Degloving 62.7
      Plication 66.7
      Ventral Lengthening 4.9
      No 62 (60.8)
      Unsure 16 (15.7)
      2 50 38.4 ± 9.4 Yes 78 (77.2) Degloving 72.3
      Plication 87.1
      Ventral Lengthening 23.8
      No 5 (5.0)
      Unsure 18 (17.8)
      3 70 55.0 ± 12.6 Yes 96 (95.0) Degloving 74.3
      Plication 69.3
      Ventral Lengthening 60.4
      No 0 (0)
      Unsure 5 (5.0)
      4 Lateral Curvature Unknown 40.0 ± 13.7 Yes 71 (71.0) Degloving 63.0
      Plication 85.0
      Ventral Lengthening 14.0
      No 13 (13.0)
      Unsure 16 (16.0)
      a Multiple answers allowed.

      Keywords

      Abbreviations:

      PC (penile curvature), SPU (Societies for Pediatric Urology), DP (dorsal plication), VL (ventral lengthening)
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