title: Different outcomes of hypospadias surgery between north america, europe and china: is patient age a factor?
abstract: BACKGROUND AND OBJECTS: The patient's age at the first hypospadias repair may be an important factor for determining postoperative outcomes. Age at the first procedure differs between Western countries and medical centers in China. This review examines the differences between the incidence of surgical complications and surgical age in boys receiving hypospadias repairs in North America, Europe and China.
  
  
  METHODS
  Literature reports were reviewed in PubMed and WanFang databases using the key terms and phrases; 'hypospadias outcomes', 'complications of hypospadias repair' and 'timing of hypospadias repair'. All peer-reviewed articles published over the past decade (2001-2011) were considered if; a full text was available, the article included age at the first hypospadias procedure and surgical complications.
  
  
  RESULTS
  In total, 16 131 patients were reported in 113 papers from North America, Europe and China according to our inclusion criteria. There was a significant difference in age at the first hypospadias surgery (P < 0.0005) and in the incidence of complications (P <0.001) between the different global regions investigated, with the earliest surgeries occurring in North American patients. Urethral fistulas were the most common complication reported in all of the regions included in this study.
  
  
  CONCLUSIONS
  Fellowship training in pediatric urology could improve surgical outcomes, particularly in young children. Younger children experience fewer complications following hypospadias surgeries, independent of training and access to resources.
authors.affiliation: Department of Pediatrics, Shanghai Ruijin Hospital, Medical School of Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Wenli
authors.initials: W
authors.lastname: Lu
authors.forename: Yuehong
authors.initials: Y
authors.lastname: Tao
authors.forename: Amy B
authors.initials: AB
authors.lastname: Wisniewski
authors.forename: Dominic
authors.initials: D
authors.lastname: Frimberger
authors.forename: Brad P
authors.initials: BP
authors.lastname: Kropp
keywords: General Surgery; Hypospadias; Outcomes Assessment