Nurse, Parent, and Surgeon Assessment of Hypospadias Outcomes

by Courtney Winn

Coauthors: S. Scott Sparks, MD Helal A. Syed, MD YuDing Wang, MD Zoë Baker, PhD, MPH Special thanks to the Institute for Nursing and Interprofessional Research grant committee for awarding this project the funding needed to conduct our research!


Background/Significance: Hypospadias is one of the most common congenital birth defects, affecting approximately 1 in 200 boys. Post-operative complications after hypospadias repair are common, and surgeons, nurses, and parents may interpret post-operative success differently.

Aims: We aim to assess parental expectations, decisional regret, and to compare clinician versus parental satisfaction related to hypospadias repair.

Methods: We will recruit 100 patients undergoing hypospadias repair at CHLA and 100 parents/legal guardians over a nine-month period. Preoperative photographs will be captured while parents’ complete surveys to assess expectations, desired outcomes, and pre-operative experiences. A Nurse Assessment will be conducted seven to fourteen days post-operatively and one to three months post-operatively. Intraoperative photographs will be taken at one to three months and twelve months post-operatively as well as parental and surgeon surveys completed to assess outcomes. Post-operative cosmesis will be assessed by a surgeon (study team member) using the Hypospadias Objective Penile Evaluation (HOPE) score, a nurse (study team member) using a Nurse Assessment, and by parents using the Pediatric Penile Perception Scale (PPPS). Concordance between surgeon, nurse, and parent scores will be evaluated using Spearman correlation. Over the one-year period after surgery, the electronic medical record will be reviewed to identify complications, and post-operative nurse calls and emails will be documented. Associations between clinical outcomes and surgeon, nurse, and parent assessments will be evaluated using logistic regression. Differences in parents’ expected versus reported outcomes will be assessed via paired t-tests.

Expected Impact: This is the first study of its type to compare surgeon, nurse, and parent assessments of hypospadias repair outcomes. This study will also identify parental priorities and expectations regarding hypospadias repair, fostering the family-centered care environment.