Parental decisional satisfaction after hypospadias repair in the United Kingdom.

BACKGROUND: In hypospadias, the aim of surgical treatment is to achieve both desirable functional and cosmetic outcomes; however, complications following surgery are common and 18% of boys require re-operation. In mild degrees of hypospadias, repair may be offered entirely to improve cosmesis, meaning parents should be fully informed of this and the potential for complications, during the consent process. Parents' decision-making may be aided by making them aware of how others in a similar position have felt about the decision that they made for their child. One method of measuring parental satisfaction is decisional regret (DR). OBJECTIVES: To assess parental satisfaction following hypospadias surgery in the United Kingdom by assessing DR and to determine the feasibility of obtaining meaningful data via a mobile phone survey. STUDY DESIGN: The National Outcomes Audit in Hypospadias database was commissioned by the British Association of Paediatric Surgeons to capture clinical information from hypospadias repairs. Following ethical approval (16/NW/0819), a text message was sent to mobile numbers in the database inviting participation in a questionnaire incorporating the validated DR scale (DRS). The primary outcome measure was mean DRS score, which was correlated with clinical information, a score of zero indicated no regret and 100 indicated maximum regret. RESULTS: There were 340 (37%) responses. The median age at the primary procedure was 16 (interquartile range 13-20) months. No DR (score = 0) was detected in 186 (55% [95%CI 49-60]) respondents; however, moderate-to-severe DR (score = 26-100) was seen in 21 (6.2% [95%CI 3.6-8.7]) respondents. On multivariate analysis, a distal meatus, a small glans and developing complications requiring repeat surgery were all associated with increased levels of regret (Table). There was no association between DR and cases performed per surgeon. DISCUSSION: Around half of respondents demonstrated no DR and postoperative complications requiring surgery were associated with the highest levels of DR, which is similar to a Canadian study. Lorenzo et al. however found that DR was associated with circumcision, which was undertaken in all boys; however, in this UK study, around a third of boys were circumcised and regret levels between those circumcised and those not circumcised were similar. The limitations of this work include the following: surgeons submitting their own data on complications and there is potential of selection bias between respondents and non-respondents as with any survey. CONCLUSIONS: Data from this study can be used to improve pre-operative counselling during the consent process. Smart mobile phone technology can be used successfully to distribute and collect parent-reported outcomes.

Long-term outcome of JJ stent insertion for primary obstructive megaureter in children.

BACKGROUND/AIM: Endoscopic stenting is an accepted treatment option for children with symptomatic or progressive primary obstructive megaureter (PROM). Here, long-term outcomes with endoscopic stenting are reviewed. METHODS: Patients with PROM treated surgically over a 12-year period were identified using a prospectively maintained departmental database. Data were analysed using Microsoft Excel 2013 and unpaired t-tests through GraphPad Software QuickCalcs. RESULTS: Fifty-seven patients with PROM were surgically managed in the study centre from 2005 to 2017. Twenty-nine of fifty-seven patients had the stent as the primary procedure, whereas the remainder had ureterostomy, re-implantation or nephrectomy. Six patients had bilateral PROM, giving a total of 35 renal units that were fully analysed. There was 7:1 male predominance, and 20 of 29 patients (69%) were diagnosed antenatally. The median age at stent insertion was 8 months (40 days-10 years); the median prestent ureteric diameter was 19 mm and the median pre-operative function on MAG3 was 44%. Cystoscopic stent insertion was feasible in all patients. The stent was left for a median of 183 days. In 9 of 35 (26%) renal units, the JJ stent was a successful sole long-term treatment, with median follow-up of 5 years and 8 months. The success rate was not different in children aged <1 year (8/22; 36%) in comparison to children aged >1 year (1/13; 8%), P = 0.1. The remaining 26 renal units required further surgical intervention: ureteric re-implantation in 25 and nephrectomy in one. Indications for further surgery were stent complications in 11 renal units and stent failure in 15 (Table 1). Complications related to the stent were noted in 14 renal units (41%), half being stent migration. Other complications included UTIs, stent encrustation and recurrent haematuria. There was no identifiable prestent parameter, whether clinical or radiological, that could predict which patients were likely to be successfully managed solely by stent insertion. Stent insertion was never successful as a definitive procedure when the distal ureteric diameter was >12 mm on the ultrasound after stent removal. DISCUSSION: Success rates with primary stenting as a sole treatment for PROM was 26%, which is less than that seen in other reports (50-66%). This may be attributed to the long-term follow-up in this study, together with the strict criteria for success. CONCLUSION: In the authors' experience, cystoscopically inserted JJ stents are of limited success as the sole treatment for PROM. In infants aged <1 year, stent insertion remains a reasonable temporising measure until the infant is old enough for a definitive procedure.