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Pediatric Surgery International

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01-12-2023 | Hypospadia | Original Article

Unaided visual assessment of ventral curvature during hypospadias repair is inferior to objective measurement using app goniometry

Authors: Ramesh Babu, D Arun Prasad, V. V. S. Chandrasekharam

Published in: Pediatric Surgery International | Issue 1/2023

Abstract

Objective

Failure to perform artificial erection or objectively assess ventral curvature (VC) during primary hypospadias repair is an important reason for residual/ recurrent chordee. The present study compares the accuracy of unaided visual inspection (UVI) with objective VC assessment using smartphone application (app) goniometry.

Methods

All patients who underwent primary hypospadias repair between January 2021 and September 2022 were included. Assistant surgeons were asked to grade the degree of VC on UVI (after degloving and an artificial erection test) into: none, mild (<30 degree), severe(>30 degree). Lateral profile photograph was taken and angle measurement was performed on an android mobile application (Angulus). Correlation was performed with both methods of assessment.

Results

During this period a total of 210 patients were analyzed; VC was noted in 40/138 (29%) cases of distal and in 62/72 (86%) cases of proximal hypospadias. Erroneous visual inspection was noted in 41/210 (20%; 95% CI 14-25%) on UVI (15 erroneously marked none while 26 marked mild). Among those found to have chordee, UVI assessed 39/82 (47%) as severe while app goniometry assessed 65/97 (67%) as severe. There was significant relative risk of labelling severe chordee as a mild one by UVI: 1.4 (95%CI 1-1.8; p=0.01).

Conclusions

UVI was erroneous in 20% of cases. UVI was less accurate in differentiating severe chordee from mild one. In 60% patients UVI alone could have led to erroneous VC assessment and thus wrong selection of technique. Further studies are required to validate our findings and standardize VC measurement using an app goniometry.

Snodgrass W, Bush NC (2019) Persistent or recurrent ventral curvature after failed proximal hypospadias repair. J Pediatr Urol 15:344.e1-344.e6. https://doi.org/10.1016/j.jpurol.2019.03.028CrossRefPubMed

Pippi Salle JL, Sayed S, Salle A et al (2016) Proximal hypospadias: a persistent challenge. Single institution outcome analysis of three surgical techniques over a 10-year period. J Pediatr Urol 12:28.e1-28.e7. https://doi.org/10.1016/j.jpurol.2015.06.011CrossRefPubMed

Moscardi PRM, Gosalbez R, Castellan MA (2017) Management of high-grade penile curvature associated with hypospadias in children. Front Pediatr. https://doi.org/10.3389/fped.2017.00189CrossRefPubMedPubMedCentral

Babu R, Chandrasekharam VVS (2022) A meta-analysis comparing dorsal plication and ventral lengthening for chordee correction during primary proximal hypospadias repair. Pediatr Surg Int. https://doi.org/10.1007/s00383-022-05065-7CrossRefPubMed

Villanueva CA (2019) Goniometer not better than unaided visual inspection at estimating ventral penile curvature on plastic models. J Pediatr Urol 15:628–633. https://doi.org/10.1016/j.jpurol.2019.09.020CrossRefPubMed

Villanueva CA (2020) Ventral penile curvature estimation using an app. J Pediatr Urol 16:437.e1-437.e3. https://doi.org/10.1016/j.jpurol.2020.04.027CrossRefPubMed

Acimi S, Boukli-Hacene A (2005) Interest of mobilization of the urethral plate in the release of chordee related to posterior hypospadias. Prog en Urol J l’Association Fr d’urologie la Soc Fr d’urologie 15:59–62

Fernandez N, Flórez-Valencia L, Prada JG et al (2021) Standardization of penile angle estimation with a semi-automated algorithm. J Pediatr Urol 17:226.e1-226.e6. https://doi.org/10.1016/j.jpurol.2021.01.006CrossRefPubMed

Mosa H, Paul A, Solomon E, Garriboli M (2022) How accurate is eyeball measurement of curvature? A tool for hypospadias surgery. J Pediatr Urol 18:470–476. https://doi.org/10.1016/j.jpurol.2022.04.009CrossRefPubMed

10.

Hsi RS, Hotaling JM, Hartzler AL et al (2013) Validity and reliability of a smartphone application for the assessment of penile deformity in Peyronie’s disease. J Sex Med 10:1867–1873. https://doi.org/10.1111/jsm.12136CrossRefPubMed

11.

Abbas TO (2022) Evaluation of penile curvature in patients with hypospadias; gaps in the current practice and future perspectives. J Pediatr Urol 18:151–159. https://doi.org/10.1016/j.jpurol.2021.12.015CrossRefPubMed

12.

Castagnetti M, El-Ghoneimi A (2022) Surgical management of primary severe hypospadias in children: an update focusing on penile curvature. Nat Rev Urol 19:147–160. https://doi.org/10.1038/s41585-021-00555-0CrossRefPubMed

13.

Abbas TO, AbdelMoniem M, Chowdhury MEH (2022) Automated quantification of penile curvature using artificial intelligence. Front Artif Intell 5:954497. https://doi.org/10.3389/frai.2022.954497CrossRefPubMedPubMedCentral

14.

Siapno AED, Yi BC, Daniels D et al (2020) Measurement accuracy of 3-Dimensional mapping technologies versus standard goniometry for angle assessment. J Pediatr Urol 16:547–554. https://doi.org/10.1016/j.jpurol.2020.08.021CrossRefPubMed

15.

Tripepi G, Jager KJ, Dekker FW et al (2008) Bias in clinical research. Kidney Int 73:148–153. https://doi.org/10.1038/sj.ki.5002648CrossRefPubMed

16.

Villanueva CA (2022) No joints in the penis. J Pediatr Urol 18:477. https://doi.org/10.1016/j.jpurol.2022.04.025CrossRefPubMed

Title: Unaided visual assessment of ventral curvature during hypospadias repair is inferior to objective measurement using app goniometry
Authors: Ramesh Babu
D Arun Prasad
V. V. S. Chandrasekharam
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keyword: Hypospadia
Published in: Pediatric Surgery International / Issue 1/2023
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-023-05499-7

2024 ASCO Annual Meeting

Springer Medicine

Unaided visual assessment of ventral curvature during hypospadias repair is inferior to objective measurement using app goniometry

Abstract

Objective

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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