Concordance of Expert and Parental Opinion about Hypospadias Surgical Outcome Is Severity Dependent

Abstract

IntroductionHypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity.Materials and methodsParents of children who had undergone hypospadias repair were recruited for this study (n = 104). A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen’s kappa (κ) coefficient was used to assess interobserver agreement and Chi Square “Goodness of Fit” Test was used to determine probability of satisfaction.FindingsConcordance on the level of satisfaction with surgical outcomes for Type cases I was slight (κ = 0.20; CI 95% 0–0.60), for Type II cases was moderate (κ = 0.54; CI 95% 0.13–0.94), and for Type III cases was substantial (κ = 0.62; CI 95% 0–0.56). However, the probability of satisfaction did not change according to severity (Chi Square “Goodness of Fit” Test; parents, p = 0.84; pediatric urologists, p = 0.92). These results cannot be explained by parental health literacy according to SAHLSA-50 test scores.ConclusionThe level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.

Health Literacy in Surgery

“…Studies to date have not found an association between health literacy and patient satisfaction with respect to their hospital stay, outcomes, or interactions with care team (Komenaka et al, 2014;Menendez, Chen, Mudgal, Jupiter, & Ring, 2015;Perez-Brayfield et al, 2016); however, a single study did evaluate health literacy and patient satisfaction with his or her decision to undergo surgery and the informed consent process (Hallock et al, 2017). Hallock et al (2017) measured patient satisfaction using a scale measuring "satisfaction with decisions" and found that highly satisfied patients scored higher on the informed consent questionnaire that measured knowledge of planned procedure; however, there was no statistically significant difference in health literacy rates between the patients who were highly satisfied versus those who were not.…”

Age of the Mother as a Risk Factor and Timing of Hypospadias Repair According to Severity

“…Therefore, it would be advantageous to have counseling and referral algorithms in place to manage severe hypospadias cases when diagnosed during prenatal care. Irrespective of the unsettled ground with regard to the best timing for hypospadias repair, timely information and early referral to pediatric urology can help couples to better assess treatment options and to have real expectations about surgical outcomes [35]. We advocate for inter-professional communication between genetic counselors, psychologists, obstetricians, pediatricians and pediatric urologists to champion quality of service in urogenital care.…”

New frontiers on the molecular underpinnings of hypospadias according to severity

“…In fact, it has been shown that parental decisional regret is influenced by surgical outcomes [ 79 ]. Interestingly, the level of agreement between parents and the paediatric urologist concerning satisfaction with surgery is greater for severe rather than for mild cases [ 80 , 81 ]. Taken together, in the future, additional information provided by molecular genetics screening prior to the urethroplasty procedure may nurture open discussions with parents about expected outcomes.…”