Hypospadias: The lay of the land.

[INTRODUCTION] Hypospadias surgery is uniquely split across the specialities of paediatric surgery urology and plastic surgery. The division may restrict best practice as there is a paucity of cross-speciality forum for discussion and dissemination. Separately achieving training competence is a challenge. The authors present a travelling fellowship as a template future programme to address some of these issues.

[METHODS] A fellowship was established visiting seven UK hospitals. Surveys were sent to mentors and plastics trainees via the BAPRAS Specialist Interest Group and Plastic Surgeon Trainee Association RESULTS: The fellowship structure is presented. The survey of consultant practice found the Snodgrass Tubularised Incised Plate urethroplasty was universally used for single stage repairs. Multi-stage repairs saw cross-speciality convergence on Bracka or the staged tubularised auto-graft / STraighten and Close Staged Repair. Variation was seen in the use of testosterone, suture selection, urinary diversion and the availability of a multidisciplinary team and a disorders of sexual differentiation clinic. Fifty percent of plastic trainees had hypospadias exposure during training.

[CONCLUSION] An established fellowship could spearhead a new era of improved collaboration across the three surgical specialities, with an aim to improve training and patient outcomes. The trainee survey shows a lack of formal exposure to hypospadias in plastic surgery. The survey of practice shows that surgeons are practicing in district level to quaternary hospitals, but surgeon caseload did no relate to size of hospital. The use of a 'spoke and wheel' MDT concept is suggested to support small units.