Hypospadias surgery in plastic surgery: a snapshot of today with an eye on tomorrow.

The current provision of hypospadias correctional surgery lies across the specialities of paediatric surgery, general surgery, urology and plastic surgery. This study aimed to look at how this provision is structured within plastic surgery, what plastic surgeons are currently doing and how this impacts on training. All plastic surgery units within the UK were contacted via letter and telephone in order to ascertain their current practice with regard to hypospadias surgery. Specialist registrars in the West Midlands Deanery were also questioned on their training in this area. The results indicate that 42 plastic surgeons in the UK carry out hypospadias surgery. The majority of clinicians use the Bracka two-stage repair (88%), with Snodgrass (45%) and MAGPI (43%) widely used. Operations are being carried out across the age spectrum from birth, with 51% favouring intervention at 3 years or more. Approximately two-thirds of plastic surgeons treat less than 25 patients per year. One-third treat 26 to 50, with only two clinicians claiming to treat more than 50 patients per year. Of the specialist registrars questioned in the West Midlands Deanery the majority (74%) were confident with the assessment of new cases and in obtaining consent. One-quarter of registrars (28%) only wished to carry out hypospadias surgery once they were consultants, with only one feeling that they had the necessary training to achieve this now. Plastic surgeons represent about half (52%) of the consultants currently identified in the UK as carrying out hypospadias surgery. If this provision is to be maintained then a greater opportunity for development of skills and experience needs to be created within plastic surgery training. The authors advocate the formulation of a coordinated national framework for the provision of this service, promoting a regional focus for skills and governance.