Assessment of the CDC hypospadias atlas for epidemiological research - A survey of experts.

Background: Hypospadias is a common congenital malformation. There are several classification systems for hypospadias. However, the phenotypic subtypes of hypospadias are inconsistently reported across databases due to the inherently subtle variability of the penile anatomy. Consistent classification of hypospadias would enable more accurate data regarding etiological correlates of specific subtypes as well as perioperative care and surgical outcomes. Existing classifications are designed for use by hypospadias surgeons, although there is a need for a system for epidemiologic data abstractors, who are generally not clinicians. The online Center for Disease Control (CDC) manual for birth defect surveillance includes a hypospadias atlas with photograph representation for different hypospadias phenotypic subtypes. However, this atlas is not widely known or used as a reference by pediatric urologists. We sought to evaluate the consistency amongst surgeons who specialize in managing this condition on the classification of hypospadias using the CDC atlas to determine whether this can be a tool in epidemiologic data collection.

Method: We developed a questionnaire using photographs taken directly from the CDC atlas for hypospadias. Demographic data regarding geographical location and years in practice also were obtained. The survey was distributed via email to members of the Society for Pediatric Urology and American Association of Pediatric Urologists. Responses were anonymously collected.

Result: 166 responses were received from 407 surveys request yielding a response rate of 40.8 %. Agreement with the CDC atlas on the classification of hypospadias by responders was 93.4 % for glanular hypospadias, 56.6 % for subcoronal hypospadias, 3.6 % for penile hypospadias, 54.2 for scrotal hypospadias, and 59 % for perineal hypospadias.

Conclusion: Our survey indicated that there is general disagreement in classification of hypospadias in the CDC atlas amongst members of pediatric urology societies. There exists a need for better standardization of a hypospadias classification system for epidemiologic research in hypospadias. Limitations of our study include a less than 50 % of survey responses received and large proportion of responders were from the United States.