Letter to the Editor|Articles in Press

Response to letter to the Editor re: Variability in surgical practices and instrumentation for hypospadias repair

  • Renea Sturm
    Correspondence to: Renea Sturm 200 Medical Plaza, #170, Los Angeles, CA 90095, USA
    Division of Pediatric Urology, Department of Urology, University of California, Los Angeles
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  • On behalf ofthe Western Pediatric Urology Consortium
Published:February 26, 2023DOI:
      There are an array of factors that contribute to variability in hypospadias repair, with few surgical procedures demonstrating such extensive surgeon-to-surgeon and patient-to-patient differences. The current project was the broadest network study reported to date evaluating the procedural descriptions provided in operative notes and templates describing hypospadias repairs. The key findings are that 1) procedural descriptions vary widely by surgeon across categorically similar hypospadias repairs and 2) templates provided key technical details across a broad network, aligning closely with reported common techniques by surgeon. Of note, this is not an outcomes study, nor is it a phenotype evaluation, as these were not the aims of this scoping project. Certainly, all of this information is needed, and collaboration will be the key to ensure that broad data sets are captured that contain standardized data collection of anatomic phenotype, surgical technique, and short- and long-term clinical outcomes.
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      Linked Article

      • Surgical process variables for the classification of hypospadias
        Journal of Pediatric Urology
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          I read the article published by the Western Pediatric Urology Consortium (WPUC) network on identifying variability in surgical practices and instruments used for hypospadias repair [1]. Despite the authors' efforts, I think it is not possible to use this study to understand what variables can be reliably measured for future surgical outcomes in hypospadias. There are mainly two types of variables to measure in surgical research studies: patient outcomes and surgical process. In fact, almost all “variables” in this study are patient, surgeon and procedure-related confounding variables and/or contributing factors (such as patient classification as distal TIP and proximal hypospadias, level of expertise of practicing fellow surgeons, operative templates, tissues used, suture types and catheter selection, etc.), making it difficult to draw valid conclusions.
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