Development of individualized surgical strategies for pediatric hypospadias: a multicenter penile morphometric analysis

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.