ESPE Abstracts

Introduction: The outcome of hypospadias is considered to be primarily dependent on the underlying aetiology, its surgical management and the duration of follow-up. However, currently, there is little consensus on what set of parameters are essential and clinically feasible for assessment of outcome.

Aim: To facilitate the development of a core outcome set for hypospadias by assessment of the range of outcomes reported in boys undergoing surgery.

Methods: Using the terms ‘outcome’ and ‘hypospadias’, pubmed was searched to identify randomised controlled trials, case controlled trials, case series, and prospective cohorts reporting on short and long term outcomes in males with hypospadias published in the English language from 2008 to 2017. All publications reporting on outcomes in males after primary surgery were included as were mixed series with cases after primary and redo surgery. All reported outcomes were systematically extracted by a single person and a subset verified by a second person.

Results: Of 878 publications, 274 met the eligibility criteria. Although 70 different outcomes were reported, only 18 (26%) were reported in more than 10% of the publications. On categorization into four age groups, based on the age of the patient at the time of reported outcome, the majority of studies examined short-term outcome (1-5 years n=133 (49%), 6-10 years n=65 (24%), 11-16 years n=33 (12%), and >16 years n=36 (13%), unclear n=7 (2%)). Overall, urethrocutaneous fistula was most commonly reported (n=236 publications (85%)), and this was consistent across all ages. Among boys aged 1–5 and 6–10 years, meatal stenosis, dehiscence, and urethral strictures were next most frequent (n=94 (71%), n=87 (65%), n=56 (42%) and n=38 (59%), n=35 (54%), n=36 (55%) respectively). In the older age categories, there was an increasing frequency of other reported outcomes including cosmesis, meatal shape/location and genital skin changes (11–16 years, n=16 (49%), n=19 (58%), n=7 (21%), and >16 years, n=20 (56%), n=21 (58%), n=12 (33%)). Outcomes reflecting sexual health, erection, and relationship status including paternity were reported in the >16 year olds (n=22 (61%), n=21 (58%), n=12 (33%)). Redo surgery was reported similarly across age groups (n=76 (27.2%)).

Discussion: The current study identifies the range of parameters that are measured to assess outcome and the extent of consensus. This review can be used to inform the development of a core outcome set that can be applied as a standardized assessment tool in a routine clinical setting in an age dependent manner.