title: Surgical outcomes and cultural perceptions in international hypospadias care.
abstract: OBJECTIVE
  This study was designed to assess perceptions of untreated hypospadias and quality of life in culturally disparate low or middle income countries, to highlight the demographic and care differences of patient groups treated for hypospadias in the surgical workshop context, and to evaluate the long-term outcomes achieved by these workshop groups.
  
  
  METHODS
  Family member perceptions of hypospadias, perioperative process measures and urethrocutaneous fistula rates were compared between 60 patients from Vietnam and Senegal treated for hypospadias through training workshops by local surgeons and pediatric urologists from the U.S. between 2009 and 2012, of whom approximately 42% had previously undergone repair attempts.
  
  
  RESULTS
  More than 90% of respondents surveyed believed that untreated hypospadias would affect the future of their child at least to some degree. Patient cohorts between the 2 sites differed from each other and published high income country cohorts regarding age, weight for age and frequency of reoperation. Telephone based outcomes assessment achieved an 80% response rate. Urethrocutaneous fistula was reported in 39% and 47% of patients in Vietnam and Senegal, respectively.
  
  
  CONCLUSIONS
  Family members perceived that the social consequences of untreated hypospadias would be severe. Relative to patient cohorts reported in practices of high income countries, our patients were older, presented with more severe defects, required more reoperations and were often undernourished. Urethrocutaneous fistula rates were higher in cohorts from low or middle income countries relative to published rates for cohorts from high income countries. Our study suggests that outcomes measurement is a feasible and essential component of ethical international health care delivery and improvement.
authors: Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts; Department of Urology, University of California San Francisco, San Francisco, California. Electronic address: ian.metzler@childrens.harvard.edu.
authors: Ian S
authors: IS
authors: Metzler
authors: Department of Urology, Children's Hospital Boston, Boston, Massachusetts; IVUmed, Salt Lake City, Utah.
authors: Hiep T
authors: HT
authors: Nguyen
authors: Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts; Pediatric Surgery and International Pediatrics, Department of Clinical Sciences, Lund Faculty of Medicine, Lund University, Lund, Sweden.
authors: Lars
authors: L
authors: Hagander
authors: Hôpital Général de Grand Yoff, Dakar, Senegal.
authors: Mohamed
authors: M
authors: Jalloh
authors: Khanh Hoa Hospital, Nha Trang, Vietnam.
authors: Ton
authors: T
authors: Nguyen
authors: Hôpital Général de Grand Yoff, Dakar, Senegal.
authors: Serigne Magueye
authors: SM
authors: Gueye
authors: IVUmed, Salt Lake City, Utah; Department of Urology, Primary Children's Medical Center, Salt Lake City, Utah.
authors: Catherine R
authors: CR
authors: deVries
authors: Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, Massachusetts.
authors: John G
authors: JG
authors: Meara
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003466:Cultural Characteristics; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D038622:Internationality; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome
keywords: fistula; hypospadias; male; urologic surgical procedures