Assessment Of Postoperative Outcomes Of Hypospadias Repair With Electronic Questionnaires

Purpose:Hypospadias is one of the most common congenital malformations of the genito-urinary tract in males,which accounts for about half of hospitalized children of the urology ward of Beijing children’s hospital. Surgical correction could be the only way to repair hypospadias.The traditional means to do post hospitalization follow-up should be contact with telephones,this study try to utilize electronic questionnaires to assess the postoperative functional and cosmetic outcomes of hypospadias repair,and discuss the feasibility of construting an APP platform for following up of children with hypospadias.Methods:Children who underwent hypospadias repair from Oct.2015 to Mar.2016 of Beijing chirldren’hospital were identified.The electronic questionnaires were made by Word or Photoshop in accordance with the current clinic treatment of hypospadias of Beijing children’hospital. After parents consented to participate, we emailed them the electronic questionnaires,participants can submit the assessment results through the App,or email back the picture of written answers.The results were collected and the level of interobserver variation assessed using the Fisher test,P<0.05 would be considered to reflect significant difference.Results:Collection of the questionnaire:113 parents offer their e-mail address,35 completed the survey.among the 35 parents,13 parents offer the picture of penis or voiding video of their children.Clinical features of the children interviewed:None of the 35 children interviewed have had surgical correction of hypospadias before.patients were classified according to the anatomic location of the urethral orifice before surgery.the location of the meatus preoperatively was glanular,coronal and subcoronal in 2,distal penile,midshaft penile and proximal penile in18,penoscrotal in 14,and perineal in 1.all patients have different degrees of penile chordee preoperatively.Of the 35 patients that completed the survey, the mean age at surgery was 28.8 months, one child Was 8 years and 2 months,the rest 34 children were all younger than 3years and 3 months as they accept the surgical repair. The procedure used included Duckett repair in 24,Duckett+duplay repair in 2,Snodgrass repair in 6, Onlay repair in 2, one child with the meatus on the distal simply correcte the penile curvature without urethroplasty.Calculated at 30 days a month,the time from procedure to follow-up,14 children were within 3 monthes,the rest 21 children were from 3 months to about 6 months.Results of the collected questionnaires:1.Assessment of the cosmetic outcome after surgical correction:33 of 35(94.3%)patients had a meatus located on the distal glans after operation,26 of 35(74.3%)patients achieved a slit-like, vertically orientated meatus,30/35(85.7%) had normal shape of glans,8/35(22.9%)had the regular appearance of their penis as circumcised children,24/35(68.6%)of parents shows that the appearance of their children’s penis was relatively less regular as circumcised children.2.Assessment of the urinary function:Of the 35 children,one child voiding through the urethral fistula on the penoscrotal,with no urine voiding from the distal urethral opening,34 children could voiding from the distal urethral opening,of the 34 children,28(82.4%)achieving a single stream,6 children(17.6%)experienced spraying of urine;17(50%) had varying degrees of urine deflection.3.Rate of complication after surgery:16(45.7%)children had complications as interviewed,12 children(34.3%) had urethral fistula,3 children(8.6%) had urethral diverticulum,2(5.7%)had been diagnosised to be with Urethral stricture and received urethral dilation,one child were supposed to be with urethral stricture,but not returned for further inspection.Reaeacher contact17 parents who expressed with no urethral fistula of their children when interviewed,6(35.3%)of the parents shows that their children used to be with urethral fistula,but heal on its own afterwards.4.Assessment of the correction of penile curventure and erectile function:29 of 35 children(82.9%)achieved a straight erection,5 children( 14.3%)experiencing mild angulation,one child( 2.8%) experiencing moderate or severe angulation 。 19 received the evalution of penile torsion and lateral bending, 12( 63.2%) parents showed their children were within the normal range of penile torsion and lateral bending,7(36.8%)showed their children had either problems of penile torsion or lateral bending.5、Satisfaction investigation after operation:19/35(54.3%)of parents showed they were satisfied with the cosmetic outcome after operation,27/35(77.1%)were satisfied with the urinary function,25/35(71.4%)were satisfied with the general outcome of operation。Conclusions:1.The majority of patients after operation of hypospadias of Beijing children’ hospital could achieved an desirable cosmetic outcomes,which may contains a slit-like,vertically orientated meatus on the distal glans,a glans with normal shape,and a relatively regular foreskin appearance as circumcised children.2.Urine deflection and the spraying of urine are common problems after hypospadias repair,a majority of children after operation will have different degrees of urine deflection and urine spraying.3.Children with hypospadias will have high rate of surgical complication early in the postoperative period,urethral fistula is the most common complication following hypospadias surgery.A considerable part of urethral fistula appeare early in the postoperative period may heal on its own。4.The majority of patients after operation of hypospadias of Beijing children’ hospital could achieved an desirable outcome of penile curventure correctio, a small percentage of people may have certain degrees of penile torsion or lateral bending.5.More than half parts of children’s parents of Beijing children’ hospital showed that they were satisfied with the outcome of their children after hypospadias repair.6.The electronic questionnaires with standardized photographs and reference pictures can be use as an objective outcome measure after hypospadias surgery.Children with hypospadias will have high rate of problems early in the postoperative period,the construction of APP platform for followup of children after hypospadias repair may offer an qucik collection of clinical infomation and can simplify manual workload,the follow-up early in the postoperative period may also help parents find hidden complications,and contribute to rehabilitation of the children.