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A Checklist-Based Approach to Complex Hypospadias: Surgical, Genetic and Endocrine Insights From a Multidisciplinary
Bandar Alsahn1, Amit Nagpure1, Claire Sharpin1
1Department of Urology, The Children's Hospital at Westmead, Sydney, Australia.
Journal of Paediatrics and Child Health
|July 27, 2026
Summary
A new checklist for complex hypospadias (CH) management streamlines multidisciplinary team reviews. Anatomical severity, not genetic or endocrine factors, predicts early surgical outcomes in CH patients.
Area of Science:
- Pediatric Surgery
- Medical Genetics
- Pediatric Endocrinology
Background:
- Complex hypospadias (CH) requires thorough surgical, genetic, and endocrine assessment.
- Standardizing care for CH is essential for effective multidisciplinary team (MDT) management.
Purpose of the Study:
- To evaluate the impact of a pre-operative clinical checklist on CH management.
- To streamline the MDT approach and standardize evaluations for CH.
Main Methods:
- Retrospective cohort analysis of 50 children with CH (2016-2024).
- Introduction of a structured pre-operative checklist in 2021 to standardize genetic, endocrine, and anatomical evaluations.
- Facilitation of asynchronous MDT review post-checklist implementation.
Main Results:
- The checklist was used for 35 patients, enabling 77% to bypass full synchronous MDT discussion.
- Renal anomalies (11%) and proteinuria (19%) were identified; 15% had pathogenic genetic variants.
- Anatomical complexity, not genetic/endocrine issues, drove 32% of revision surgeries.
Conclusions:
- The pre-operative checklist streamlines MDT review for CH, potentially reducing missed investigations.
- It supports a structured approach to informed surgical consent for CH.
- Anatomical severity is the primary predictor of early surgical outcomes in CH, despite crucial genetic/endocrine findings.
