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Hypospadias repair after pediatric urology fellowship training: A comparison of junior surgeons to their mentor
Nicol C. Bush, M.D. MSc1, Theodore Barber, M.D.2, Daniel Dajusta, M.D.3, Juan Carlos Prieto, M.D.4, Ali Ziada, M.D.5, Warren T. Snodgrass, M.D.1.
1UTSW, Dallas, TX, USA, 2Urology Consultants, P.C., Gran Rapids, MI, USA, 3University of Louisville, Louisville, KY, USA, 4Pediatrix, San Antonio, TX, USA, 5University of Kentucky, Lexington, KY, USA.
A major goal in pediatric urology fellowship training is to learn hypospadias repair. Two prior publications regarding the efficacy of transferring decision-making and technical principals from experienced surgeons to fellows reached different conclusions. Our aim was to determine urethroplasty complications (UC) in recently-graduated fellows versus their surgical mentor.
We reviewed case logs of 5 consecutive pediatric urology fellows matriculating from UT Southwestern between 2007-2011 to estimate exposure to hypospadias surgery during training. While fellows were trained in and participated with each key component of the surgery (penile straightening, urethroplasty, glansplasty, barrier flap development and skin closure) in different cases, overall participation in each case was <50%. After graduation, data was collected on consecutive patients undergoing primary distal hypospadias repair by the graduating fellows and their mentor between 9/2010-10/2012 (4 prospectively, 2 retrospectively). Only patients with <1 month follow-up were excluded. UC were defined as presence of any of the following: fistula, glans dehiscence, urethral stricture and/or meatal stenosis (<8Fr). UC were compared between junior surgeons, and between junior surgeons and the senior surgeon, using Fisher’s exact contingency test.
Case logs during training demonstrated participation in distal repairs ranging from 76-134 per fellow. All operations by all surgeons were TIP repairs. The number of patients and UC rates for the senior and junior surgeons after training (in random order) are shown in Table 1. Average follow up for all surgeons was 6 months (SD 3 mo). Despite varying case volumes after graduation, there were no differences in UC between junior faculty (p=0.62) or between junior and senior faculty (p=0.78).
Our data indicate that fellow participation in distal TIP hypospadias repair enabled junior surgeons in practice ≤5 years to achieve the same surgical results as their mentor. This occurred despite <50% participation in any given case during training. Overall complication rates ranged from 5-13% with short-term follow-up. The necessary technical and decision-making skills were successfully transferred from an experienced surgeon to trainees. While the minimum number of cases needed for technical competence as a trainee or as a practitioner is unknown, these results indicate that recent graduates were able to achieve low UC with distal TIP hypospadias repair.
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