Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis

Effectiveness of penile ventral curvature correction and the trend of hypospadias repair: a prospective study of the national center in China

BACKGROUND

Hypospadias repair is a complex surgical procedure that involves correcting penile ventral curvature (VC) and performing urethroplasty. This study aims to evaluate the effectiveness of different strategies for VC correction and analyse the trends in hypospadias repair at a national centre in China.

METHODS

Prospective data collection was conducted from 2019 to 2020 for patients undergoing hypospadias repair. The effectiveness of VC correction was assessed based on the degree of VC change with different strategies. Furthermore, the choice of surgical techniques for different types of hypospadias repair was analysed.

RESULTS

A total of 434 patients were included, with a median preoperative VC degree of 50° (35°, 70°). All patients achieved a straight penis postoperatively, with 15.2% undergoing degloving, 28.6% undergoing degloving and dorsal plication (DP), 13.1% undergoing degloving and urethral plate transection (UPT), and 43.1% undergoing degloving, UPT and DP. Degloving alone was effective in correcting VC in 57.6% of patients with VC less than 30°. In our analysis, DP after UPT resulted in a higher degree of correction (25°) compared with DP after degloving alone (20°) (p<0.001). The study identified the current trends in hypospadias repair, with tubularised incised plate urethroplasty (TIP) being the most common technique used in distal hypospadias repair (70.6% of patients) and transverse preputial island flap urethroplasty (TPIFU) being preferred for proximal hypospadias repair (63.0%).

CONCLUSIONS

Degloving alone is effective for correcting VC less than 30°. The majority of patients in our centre underwent UPT, and DP after UPT yielded better results compared with DP after degloving alone. Distal hypospadias repair commonly used TIP, while TPIFU was favoured for proximal hypospadias repair.

TRIAL REGISTRATION NUMBER

ChiCTR1900023055.

Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center

BACKGROUND

Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6 and 18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias.

METHODS

We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children's Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU Guidelines.

RESULTS

A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1 ± 16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR] = 1.562; 95% confidence interval [CI] 1.199-2.034; p = 0.001), prostatic cyst (OR = 2.613; 95% CI 1.579-4.324; p < 0.001), penile hypoplasia (OR = 1.778; 95% CI 1.225-2.580; p = 0.002), inguinal hernia (OR = 2.070; 95% CI 1.394-3.075; p < 0.001), and penoscrotal transposition (OR = 4.125; 95% CI 1.250-13.619; p = 0.020) were more likely to receive delayed surgery. Living in a low economic area (OR = 1.731; 95% CI 1.068-2.806; p = 0.026) or not close to a main medical center (OR = 1.580; 95% CI 1.370-1.824; p < 0.001) was highly associated with delayed surgery. The proportion of children undergoing delayed surgery and the median age of surgery during the COVID-19 pandemic were significantly higher than those before the COVID-19 pandemic (p = 0.004 and < 0.001, respectively).

CONCLUSIONS

Most children with hypospadias received delayed surgery (surgical age > 18 months). Comorbidities, living in a low economic area, too far from a main medical center and the COVID-19 pandemic were highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery.

Binocular temporal visual processing in myopia

Our ability to utilize binocular visual information depends on the visibility of the retinal images in each eye, which varies with both their spatial and temporal frequency content. Although the effects of spatial information on binocular function have been established, the effects of temporal frequency on binocularity are less well understood. These factors may also vary with refractive error if spatiotemporal sensitivity is affected by structural changes during the emmetropization process that may differentially affect distinct ganglion cells. In a cross-sectional study, we evaluated the potential effects of temporal and spatial frequency on binocularity in young individuals with emmetropia or myopia. Stereopsis and binocular balance were measured as a function of temporal (0-12 Hz) and spatial (1-8 c/deg) frequency. Stereopsis thresholds were measured by determining the minimum disparity at which subjects accurately identified the depth of bandpass-filtered rings. Binocular balance was measured by determining the relative contrast at which subjects reported dichoptic bandpass-filtered letters with equal frequency. Stereopsis thresholds were temporal but not spatial frequency dependent whereas binocular balance was spatial and temporal frequency dependent. There were no differences in monocular spatiotemporal contrast sensitivity between refractive groups in our sample. However, individuals with myopia showed reduced stereopsis with flickering stimuli and greater binocular imbalance at higher spatial and lower temporal frequencies compared to emmetropes. Differences in binocular vision between emmetropia and corrected myopia depend on temporal as well as spatial frequency and may be the cause or consequence of abnormal emmetropization during visual development.