A Checklist‐Based Approach to Complex Hypospadias: Surgical, Genetic and Endocrine Insights From a Multidisciplinary Model

BACKGROUND: Complex hypospadias (CH) is a challenging congenital anomaly that requires comprehensive surgical, genetic and endocrine evaluation. This study evaluates the implementation of a pre-operative clinical checklist to standardise care and streamline a multidisciplinary team (MDT) approach to CH management. METHODS: A retrospective cohort analysis was conducted on 50 children with CH managed at two tertiary paediatric hospitals between 2016 and 2024. A structured pre-operative checklist was introduced in 2021 to standardise genetic, endocrine and anatomical evaluations and to facilitate asynchronous MDT review. RESULTS: Of the 50 children evaluated (median age 18 months; median GMS score 11), 35 were managed after the checklist's introduction. The checklist enabled 77% (27/35) of these patients to bypass a full, synchronous MDT discussion. Clinical assessments revealed renal anomalies in 11% and proteinuria in 19%. Testing identified suboptimal testosterone responses in 4% and pathogenic genetic variants in 15% (7/46), with genetic testing directly influencing clinical decision-making in three patients. Among the 38 patients who underwent index surgical repair, 32% required revision surgery. Short-term surgical reintervention was driven by anatomical complexity rather than by underlying genetic or endocrine abnormalities. CONCLUSION: Implementing a pre-operative checklist for the CH streamlines the MDT review process, we hypothesise reduces the risk of missing important investigations, and supports a more structured approach to informed surgical consent. While genetic and endocrine findings are crucial for diagnosis, anatomical severity remains the primary predictor of early surgical outcomes.