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An objective hypospadias classification system.

Tariq O Abbas1

  • 1Pediatric Urology Section, Sidra Medicine, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine Qatar, Doha, Qatar; Regenerative Medicine Research Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Journal of Pediatric Urology
|June 1, 2022
PubMed
Summary

A new hypospadias severity classification system, the Urethral Defect Ratio (UDR), objectively measures urethral underdevelopment. This reliable method correlates with curvature and plate quality, improving communication in hypospadias care.

Keywords:
ClassificationHypospadiasObjectiveUrethral defectUrethral hypoplasia

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Area of Science:

  • Urology
  • Developmental Biology
  • Medical Imaging

Background:

  • Current hypospadias severity classifications based on meatus position inadequately reflect urethral hypoplasia.
  • There is a need for objective tools to assess hypospadias severity and developmental pathology.

Purpose of the Study:

  • To introduce and validate an alternative hypospadias classification system based on the bifurcation of the corpus spongiosum (BCS).
  • To objectively assess hypospadias severity by correlating the Urethral Defect Ratio (UDR) with clinical parameters.

Main Methods:

  • Calculated Urethral Defect Ratio (UDR) = (distance between glandular knobs and BCS) / stretched penile length (SPL).
  • Categorized hypospadias into three grades based on UDR values (<0.5, 0.5-0.99, ≥1.0).
  • Assessed intra- and inter-rater reliability using Inter-Class Correlation (ICC) and correlated UDR with the Plate Objective Scoring Tool (POST) and curvature using regression analysis.

Main Results:

  • The UDR ranged from 0.2 to 1.3 in 67 primary hypospadias patients.
  • UDR grades significantly correlated with hypospadias level, degree of curvature (P<0.0001), urethral plate quality (P<0.0001), and associated anomalies (P<0.05).
  • Excellent intra- and inter-rater agreement (ICC=0.998) and significant associations between UDR, POST, and curvature (P<0.001) were found.

Conclusions:

  • The UDR system provides an objective, feasible, and consistent method for classifying hypospadias severity.
  • This classification accurately reflects urethral hypoplasia and developmental etiology.
  • The UDR system enhances objective description and communication of hypospadias anomalies among clinicians.