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Volume 28, Issue 3 (May 2026) 28, 259–266; 10.4103/aja202571
Development of individualized surgical strategies for pediatric hypospadias: a multicenter penile morphometric analysis
Fang, Yi-Wei1; Song, Hong-Cheng1,2; Tang, Yun-Man3; Huang, Lu-Gang4; Yang, Yi5; Chao, Min6; Ma, Hong7; Zhang, Jing-Ti8; Zhang, Xu-Hui9; Li, Shou-Lin10; Li, Ning11; Chen, Chao12; He, Da-Wei13; Wu, Wen-Bo14; Xie, Hua15; Guan, Yong16; Yang, Yan-Fang17; Zhang, Jian-Guo18
1Department of Urology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing 100045, China
2nDepartment of Urology, Children’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hospital of Beijing Children’s Hospital, Urumqi 830054, China
3Department of Pediatric Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital (SAMSPH), Chengdu 610072, China
4Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610044, China
5Department of Pediatric Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China
6Department of Pediatric Urology, Anhui Children’s Hospital, Hefei 230022, China
7Department of Pediatric Urology and General Thoracic Surgery, Affiliated Hospital of Zunyi Medical University (Guizhou Children’s Hospital), Zunyi 563003, China
8Department of Urology, Xi’an Children’s Hospital, Xi’an 710002, China
9Department of Urology, Shanxi Children’s Hospital, Taiyuan 030013, China
10Department of Urology, Shenzhen Children’s Hospital, Shenzhen 518038, China
11Department of Pediatric Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
12Department of Pediatric Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
13Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing 400015, China
14Department of Urology, Children’s Hospital of Jiangxi Province, Nanchang 330006, China
15Department of Urology, Shanghai Children’s Hospital, Shanghai 200062, China
16Department of Urology, Tianjin Children’s Hospital, Tianjin 300134, China
17Department of Urology, Henan Children’s Hospital, Zhengzhou 450018, China
18Department of Pediatric Surgery, Inner Mongolia Maternal and Child Health Hospital, Hohhot 010020, China
Correspondence: Dr. HC Song (songhch1975@126.com)
Received: 16 February 2025; Accepted: 01 August 2025; published online: 13 January 2026
| Abstract |
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This multicenter study aimed to establish a quantitative, individualized surgical decision algorithm for pediatric hypospadias by analyzing multicenter penile anatomical data, surgical approaches, and follow-up outcomes. To achieve this purpose, clinical data from 1500 primary hypospadias cases across 17 tertiary centers in China (December 2018 to September 2021) were retrospectively reviewed, with patients stratified into urethral plate preservation group (n = 715) and transection group (n = 785). Using multivariate logistic regression, key predictors for intraoperative urethral plate transection were identified, and morphometric parameters were analyzed to guide surgical selection. This analysis led to the development of a predictive nomogram and risk stratification thresholds, which were subsequently validated. The results demonstrated that significant predictors of transection included glans length (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.07–1.29), glans width (OR: 0.35, 95% CI: 0.29–0.43), and penile curvature (OR: 1.07, 95% CI: 1.06–1.08), with the nomogram showing excellent discrimination (area under the receiver operating characteristic curve [AUC]: 0.914 in training and 0.87 in validation). Furthermore, for urethral plate preservation, a urethral plate width threshold of 4.25 mm differentiated optimal candidates for tubularized incised plate urethroplasty (width ≥4.25 mm) versus onlay island flap (width <4.25 mm). Notably, in transected cases, a urethral defect length of >3.55 cm was associated with higher complication rates in single-stage repairs (45.8% vs 33.4%, P < 0.05), favoring staged approaches. This algorithm integrates preoperative morphometrics and intraoperative measurements to provide objective, quantifiable guidance for individualized surgical planning, particularly benefiting less experienced surgeons.
Keywords: hypospadias; multicenter study; penile morphometry; surgical algorithm; urethroplasty
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