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 [
]. 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. Obviously, the variables and/or factors studied in this work cannot be correlated with the surgical outcomes. It is also interesting that the authors of WPUC classified the patients as having TIP and proximal hypospadias repairs. Unless it is a naïve approach, it needs to be discussed in detail. A hypospadias repair technique that violates the established anatomical facts cannot be used as the background to a scientific study attempting to identify the variables of hypospadias surgery. As I have mentioned in my previous reports, with glans dissection (ignoring the “septum glandis”), uniform tubularization of the neo-urethra (ignoring the “fossa navicularis”), and with the deep midline glans incision (ignoring and harming the “distal ligament”) TIPU is the biggest delusion in pediatric urology [
- Yamashiro J.R.
- Austin J.C.
- Braga L.H.
- Chuang K.W.
- Davis-Dao A.C.
- Hecht S.
- et al.
Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network.
J Pediatr Urol. 2023; https://doi.org/10.1016/j.jpurol.2022.12.001
- Özbey H.
The facts and misconceptions in hypospadias surgery.
J Pediatr Urol. 2020; 16: 408-409https://doi.org/10.1016/j.jpurol.2020.02.022
- Özbey H.
The facts and misconceptions in glans penis anatomy.
Differentiation. 2020; 113: 27https://doi.org/10.1016/j.diff.2020.03.005
- Özbey H.
- Kumbasar A.
Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications.
Turk J Urol. 2017; 43: 525-529https://doi.org/10.5152/tud.2017.00334
- Özbey H.
- Devecioğlu D.
- Staroverov O.
A closer look at iatrogenic hypospadias.
Andrologia. 2021; 53e13803https://doi.org/10.1111/and.13803
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric Urology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) network.J Pediatr Urol. 2023; https://doi.org/10.1016/j.jpurol.2022.12.001
- The facts and misconceptions in hypospadias surgery.J Pediatr Urol. 2020; 16: 408-409https://doi.org/10.1016/j.jpurol.2020.02.022
- The facts and misconceptions in glans penis anatomy.Differentiation. 2020; 113: 27https://doi.org/10.1016/j.diff.2020.03.005
- Glans wings are separated ventrally by the septum glandis and frenulum penis: MRI documentation and surgical implications.Turk J Urol. 2017; 43: 525-529https://doi.org/10.5152/tud.2017.00334
- A closer look at iatrogenic hypospadias.Andrologia. 2021; 53e13803https://doi.org/10.1111/and.13803
- “Fossa navicularis” and “septum glandis”: a flow control valve for the male urethra?.Med Hypotheses. 2020; 140109642https://doi.org/10.1016/j.mehy.2020.109642
Published online: February 22, 2023
Accepted: January 28, 2023
Received: January 25, 2023
Publication stageIn Press Journal Pre-Proof
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirectAccess this article on ScienceDirect
- Identifying variability in surgical practices and instrumentation for hypospadias repair across the Western Pediatric Urology Consortium (WPUC) networkJournal of Pediatric Urology
- PreviewAlthough hypospadias outcomes studies typically report a level or type of repair performed, these studies often lack applicability to each surgical practice due to technical variability that is not fully delineated. An example is the tubularized incised plate (TIP) urethroplasty procedure, for which modifications have been associated with significantly decreased complication rates in single center series. However, many studies fail to report specificity in techniques utilized, thereby limiting comparison between series.
- Response to letter to the Editor re: Variability in surgical practices and instrumentation for hypospadias repairJournal of Pediatric Urology
- PreviewThere 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.