Parallel Meeting on Thursday 18, June 2026, 09:55 - 10:30
09:55 - 09:58
S17-1 (CP)
Tanvir KHAN 1, Shrikesh SINGH 2 and Ayushi VIG 2
1) Dr Ram Manohar Lohia Institute of Medical Sciences, Paediatric Surgery, Lucknow, INDIA - 2) Dr RML Institute of Medical Sciences, Paediatric Surgery, Lucknow, INDIA
PURPOSE
Hypospadias is a prevalent urological condition affecting children. Since its introduction by Snodgrass in 1994, Tubularized Incised Plate Urethroplasty (TIPU), also known as the Snodgrass procedure, has gained widespread acceptance as a versatile, reproducible, and cosmetically superior single-stage technique for both distal and selected proximal hypospadias. The present prospective interventional study was therefore designed to evaluate the safety, functional and cosmetic efficacy, complication profile, and reoperation rates of single-stage TIPU in a large, consecutive series of 250 children with primary distal, mid-penile, and selected proximal penile hypospadias treated at a tertiary-care pediatric surgery center between 2021 and 2025, employing strict inclusion criteria, uniform operative technique, and systematic follow-up to a minimum of 12 months postoperatively.
MATERIAL AND METHODS
Materials and Methods
This prospective interventional study was conducted at a tertiary Pediatric Surgery teaching hospital from 2021 to 2025. During this period, 250 consecutive patients with primary hypospadias underwent single-stage tubularized incised plate urethroplasty (TIPU). Inclusion was limited to anterior (distal and mid-penile) and selected proximal penile hypospadias with a favorable urethral plate. Patients with severe proximal defects (penoscrotal, scrotal, or perineal), significant ventral curvature requiring complex dorsal plication or grafting, disorders of sex development, or previous failed hypospadias repairs were excluded. All procedures were performed under general anesthesia with caudal block supplementation. A standardized single-stage TIPU technique was employed. Patients were evaluated at 1 week (stent removal), 1 month, 3 months, 6 months, and 12 months postoperatively, and annually thereafter. Functional outcome (stream, fistula, stenosis, diverticulum) and cosmetic outcome was recorded.
RESULTS
Out of 250 consecutive patients who underwent TIPU urethroplasty, the overall complication rate was 30.6% (95% CI 25.7-35.8%). The most common complications were urethrocutaneous fistula (12.3%; 95% CI 9.1-16.2%) and meatal stenosis (11.1%; 95% CI 8.1-14.9%). Complication rates increased significantly with severity of hypospadias: 20-22% in distal, 35-38% in mid-penile, and approximately 50-55% in proximal types (p<0.001). No major complications such as complete dehiscence or glans breakdown occurred. All patients ultimately achieved satisfactory functional and cosmetic outcomes.
CONCLUSIONS
Success with TIPU remains heavily dependent on meticulous case selection, with the quality, width, and elasticity of the urethral plate being the most critical determinants. In unsuitable cases—particularly those with a narrow, deeply grooved, or inelastic plate—surgeons are strongly advised to avoid TIPU and consider alternative or staged approaches in order to minimize complications and optimize long-term results.
09:58 - 10:01
S17-2 (CP)
Cynthia Sze-Ya TING
Chang Gung Memorial Hospital, Pediatric Surgery, Taoyuan, TAIWAN
INTRODUCTION
The TAIPEI (TAping Inbetween PEnile Incisions) procedure is a novel technique designed to correct penile curvature persists after transection of the urethral plate without corporotomy or dorsal plication. Preliminary short-term outcomes were promising and have been published previously. This study aimed to evaluate the maintenance rate of successful penile straightening before school age and to assess the mid-term complication rate among hypospadias patients who underwent the TAIPEI procedure with two-stage flap repair between 2020 and 2021.
MATERIAL AND METHODS
We followed the 64 primary hypospadias patients with whom the preliminary outcomes have been previously published. As our practice routine, families were instructed to return for follow-up evaluation after toilet training. During follow-up, penile curvature was assessed based on parental report, photographs of spontaneous erections provided by caregivers, or direct observation of natural erections during physical examination.
RESULTS
Fifteen patients with a follow-up shorter than two years were excluded. Among the remaining 49 patients, the median follow-up duration was 3.6 years (IQR 3.1–4.0), and the median age at the last visit was 5.4 years (IQR 5.0–6.0). The median ventral curvature (VC) angle at stage 1 was 55° (IQR 43°–72°). All patients underwent urethral plate (UP) transection followed by the TAIPEI procedure. The median penile curvature significantly improved to 0° (IQR –5.75°–0°) at stage 2 (p< 0.001).
Based on available information at the latest follow-up, the VC angle remained stable at 0° (IQR 0–0), showing no significant difference compared with stage 2 (p= 0.098). Penile curvature was categorized as straight (0°, 69%, n = 34), and mild (≤30°, 8%, n = 4); while some were inconclusive (22%, n = 11). The most pronounced curvature observed at follow-up was 30° in two patients. A total of seven patients required reoperation (four for urethrocutaneous fistula and three for diverticulum). Overall, 78% (37/49) of patients had a penile curvature ≤30° at the latest follow-up, and no patient required reoperation for recurrent penile curvature.
CONCLUSIONS
These findings indicate that the TAIPEI procedure effectively corrected penile curvature in two-stage repair, with a sustained straightening effect at least before school age. Further long-term follow-up is warranted to confirm the durability of these outcomes.
10:07 - 10:10
S17-3 (CP)
Jeffrey HUYNH 1, Fred VAN DER TOORN 2, Barbara KORTMANN 3, Jeroen SCHEEPE 2, Piet CALLEWAERT 4, Katja WOLFFENBUTTEL 2, Eric VAN DER HORST 5, Martijn STEFFENS 6, Aart Jan KLIJN 1, Keetje DE MOOIJ 7, Josine QUAEDACKERS 8, Allon VAN UITERT 3, Martje SCHOTMAN 9, Pauline TOET-OSTENDORF 7 and Rogier SCHROEDER 7
1) Univeristy Medical Centre Utrecht - Wilhelmina Children's Hospital, Urology, Utrecht, NETHERLANDS - 2) Erasmus University Medical Center - Sophia Children's Hospital, Pediatric Urology, Rotterdam, NETHERLANDS - 3) Radboud University Medical Center - Amalia Children's Hospital, Pediatric Urology, Nijmegen, NETHERLANDS - 4) Maastricht University Medical Center, Urology, Maastricht, NETHERLANDS - 5) Amsterdam University Medical Center, Urology, Amsterdam, NETHERLANDS - 6) Isala Hospital, Urology, Zwolle, NETHERLANDS - 7) Univeristy Medical Centre Utrecht - Wilhelmina Children's Hospital, Pediatric Urology, Utrecht, NETHERLANDS - 8) University Medical Center Groningen, Urology, Groningen, NETHERLANDS - 9) Haga Hospital - Juliana Children's Hospital, Pediatric Urology, Den Haag, NETHERLANDS
PURPOSE
Research in hypospadias has primarily focused on surgical techniques and complications. Penile appearance has received less attention in literature. Studies comparing parental perception and level of satisfaction of the penile appearance before and after surgery are lacking. In this study we analyzed parental perception score (PPS), parental satisfaction rate (PSR) and the validated HOPE (Hypospadias Objective Penile Evaluation)-score. Our hypothesis is the 2 parental tools can show similar improvement as the HOPE-score between pre- and postoperative penile appearance.
MATERIAL AND METHODS
Data were obtained from the multicenter, prospective Dutch Hypospadias Study. Penile appearance was evaluated by 3 independent pediatric urologists using the HOPE-score on standardized photographs of anonymized patients. Parents assessed penile appearance pre- and postoperatively using the PPS, mirroring the HOPE-score items (meatal position, meatal shape, glans shape, skin shape, torsion). Parents received one reference photograph illustrating normal appearance for the 3 shape-related items.
Additionally, parents rated their level of satisfaction with their son’s penile appearance on a 10-point scale (PSR). All assessments were performed pre- and at 6 months postoperatively, and statistical analyses tested for significant differences between pre- and postoperative scores.
RESULTS
Of 666 patients with complete pre- and postoperative PPS and PSR data, 154 had glanular, 435 (sub)coronal/distal penile shaft, and 77 midshaft/proximal hypospadias. Parents consistently rated PPS high (median 8.4 to 9.4). Median PSR increased from 5 preoperatively to 8 postoperatively, while HOPE improved from 5.6 to 8.1. The median improvement of PPS, PSR, and HOPE were 1, 3, and 3.8, respectively. Preoperatively, a significant difference existed between the PSR and HOPE-scores, which was no longer observed postoperatively. Level of improvement was best reflected by the HOPE score, followed by the PSR, although a significant difference was observed between the two tools (p < 0.05).
CONCLUSIONS
The validated HOPE score showed the highest median improvement in penile appearance 6 months postoperatively. The PSR also demonstrated substantial improvement, with postoperative scores closely matching the HOPE score. We recommend PSR as a suitable tool for parental evaluation after hypospadias surgery, as it outperforms the PPS in measuring improvement.
10:10 - 10:13
S17-4 (CP)
Mathilde GLENISSON 1, Valeska BIDAULT-JOURDAINNE 2, Annabel PAYE 3, Thomas LOUBERSAC 4, Pauline CLERMIDI 5, Aurora MARIANI 6, Arthur LAURIOT DIT PREVOST 7, Dinane SAMARA-BOUSTANI 8 and Thomas BLANC 1
1) Hopital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, National Reference Center CRMERCD, Paris, FRANCE - 2) Hospices Cilvils de Lyon, Hôpital Femme Mère Enfant, Department of Pediatric Surgery and Urology, Bron, FRANCE - 3) Hôpital Robert Debré, Department of Pediatric Surgery and Urology, Paris, FRANCE - 4) CHU Nantes Hôpital Mère Enfant, Department of Pediatric Surgery and Urology, Nantes, FRANCE - 5) Hôpital Armand Trousseau, Department of Pediatric Surgery and Urology, Paris, FRANCE - 6) Centre hospitalier universitaire d'Angers, Department of Pediatric Surgery and Urology, Angers Cdex 09, FRANCE - 7) Hôpital Jeanne de Flandre - CHU Lille, Department of Pediatric Surgery and Urology, Lille, FRANCE - 8) Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of pediatric endocrinology, gynecology and diabetology, National Reference Center CRMERCD and PGR, Paris, FRANCE
PURPOSE
Abnormalities of the external genitalia are frequently observed in Denys-Drash syndrome (DDS), resulting from WT1 mutations. The occurrence of Wilms tumor (WT) and/or progression to kidney failure secondary to early-onset nephrotic syndrome make the surgical management of hypospadias particularly challenging in this population. This study aimed to describe the timing of urethroplasty and to identify the potential pitfalls arising from the complex interplay of clinical events in DDS.
MATERIAL AND METHODS
We conducted a multicentric retrospective analysis of boys diagnosed with a DDS (exon 8 and 9) between 2000 and 2024.
RESULTS
We identified 27 phenotypic boys with DDS. Among them, 22 presented with abnormalities of the external genitalia, including 19 cases of hypospadias (18 proximal) and three cases of isolated penile curvature. Fourteen boys underwent urethroplasty at a median age of 1.9 years (IQR 1.0-3.2), including three procedures performed after kidney transplantation (at 2.7, 4.3, and 7.6 years of age).
Three of the 14 boys developed WT after urethroplasty.
Urethrostomy was required in three boys following urethroplasty due to:
- recurrent urinary tract infections (UTIs) secondary to urethral stenosis, prior to initiating chemotherapy for WT;
- recurrent UTIs with scarring of the renal graft despite meatoplasty;
- symptomatic urethral stenosis.
Another boy with isolated severe penile curvature required a urethrostomy after kidney transplantation due to failed urethral catheterization caused by an undiagnosed congenital urethral stenosis.
Of the five boys born after 2020, four have not yet undergone urethroplasty because of WT or renal failure.
CONCLUSIONS
The timing of hypospadias surgery in DDS is critical and must take into account the risk of WT, the progression to kidney failure with potential loss of residual urine output, and the need for kidney transplantation. Complications following hypospadias repair may jeopardize graft survival and therefore must be anticipated and carefully managed.
10:13 - 10:16
S17-5 (CP)
Felix YAM, Judy HUNG and Kenneth CHUNG
Hong Kong Children's Hospital, Department of Surgery, Hong Kong, HONG KONG
INTRODUCTION
There is a general consensus that early surgery between 6 and 18 months is ideal for hypospadias repair. However, the optimal glans width for surgery tends to be 14mm or more. As most hypospadias patients have smaller glans width than the average newborn, the glans width is often too small or difficult for surgery to proceed even at 18 months old. We aim to longitudinally review our local cohort focusing on their glans width with their age.
METHOD
We conducted a retrospective review of single stage hypospadias patients who had primary repair performed in our unit from September 2020 till August 2025. Non-Chinese patients were excluded. Patients who were diagnosed incidentally during circumcision or buried penis repair were also excluded as serial measurements were not available. Patients who received hormonal treatment prior to repair were excluded. Glans width was measured in the outpatient setting as well as intra-operatively after general anaesthesia. Surgery was arranged when their glans width had reached 14mm. A scatter plot with linear regression line was used to analyze the relationship between glans width and age.
RESULTS
There were a total of 69 patients who underwent single stage hypospadias repair in the aforementioned period. 6 patients were non-Chinese and thus excluded. 5 patients were excluded as they were diagnosed incidentally. 1 patient did not have his measurement recorded. 1 patient received prior hormonal treatment. The remaining 56 were included for analysis with a total of 298 measurements. The mean age at operation was 41.5 months (13-160 months). The mean glans width at operation was 14.5mm (13-22mm).
Glans width was found to be associated with age (F(1,54) = 102.9, p < 0.001), with glans width increasing by 0.038mm by each month (95% CI: 0.030, 0.044). Age explained approximately 26% (R2 = 0.26) of the variance in glans width. Based on our cohort, it estimates that the glans width reaches 14mm when at 57 months of age.
CONCLUSION
Our cohort suggests that many Chinese hypospadic patients may not reach the optimal surgical threshold of 14mm within the preferred age for operation. Other intervention, such as hormonal treatment or staged surgery, should be considered in order to facilitate earlier surgery.