DeLair Sean M, Tanaka Stacy T, Yap Stanley A, Kurzrock Eric A
Department of Urology, University of California, Davis Children's Hospital, Sacramento, California, USA.
J Urol. 2008 Mar;179(3):1102-6. doi: 10.1016/j.juro.2007.10.090. Epub 2008 Jan 18.
Hypospadias repair is a complex and seminal procedure that has defined the subspecialty of pediatric urology. We sought to determine the degree of training and opinions regarding the need for fellowship training to achieve necessary competence in hypospadias repair.
An electronic survey was sent to 518 urology residents and recent graduates, and to 168 practicing pediatric urologists. Nonresponders were resent the survey 2 additional times. The survey consisted of basic questions on level of training or years in practice. Residents and practicing pediatric urologists were asked about the level of resident participation for each step of the hypospadias procedure, and opinions on the necessity of fellowship training. Data were analyzed for statistical differences with Wilcoxon rank sum and multiple and logistic regression tests.
Surveys were completed by 89 pediatric urologists and 208 urology residents or recent graduates (response rate 53% and 40%, respectively). Approximately 70% of residents and attending physicians report that less than 50% of the overall hypospadias procedure is performed by the resident. There appears to be agreement between residents and attending physicians regarding the perceived amount of resident participation for all steps of the procedure except glanular mobilization. Additionally, 71% of residents and 86% of attending physicians believe that a pediatric fellowship is necessary to perform hypospadias surgery.
The majority of residents and attending physicians report limited resident participation in hypospadias surgery. Residents and attending physicians have significant agreement on perceived participation. Our data do not corroborate the program data regarding the role of urology residents in hypospadias repair. The majority of residents and pediatric urologists believe specialized training is required to perform hypospadias surgery.
尿道下裂修复术是一项复杂且具有开创性的手术，它界定了小儿泌尿外科这一亚专业领域。我们试图确定在尿道下裂修复术方面达到必要能力所需的培训程度以及对于专科培训必要性的看法。
向518名泌尿外科住院医师和近期毕业生以及168名执业小儿泌尿外科医生发送了电子调查问卷。未回复者又额外收到2次该调查问卷。调查问卷包含关于培训水平或执业年限的基本问题。询问住院医师和执业小儿泌尿外科医生关于尿道下裂手术每一步骤中住院医师的参与程度，以及对专科培训必要性的看法。使用Wilcoxon秩和检验、多重回归和逻辑回归检验对数据进行统计差异分析。
89名小儿泌尿外科医生以及208名泌尿外科住院医师或近期毕业生完成了调查问卷（回复率分别为53%和40%）。约70%的住院医师和主治医师报告称，住院医师参与的尿道下裂手术整体比例不到50%。住院医师和主治医师在手术除龟头游离步骤外的所有步骤中对住院医师参与程度的认知上似乎达成了一致。此外,71%的住院医师和86%的主治医师认为进行尿道下裂手术需要小儿专科培训。
大多数住院医师和主治医师报告称住院医师在尿道下裂手术中的参与有限。住院医师和主治医师在认知参与度方面有显著共识。我们的数据与关于泌尿外科住院医师在尿道下裂修复术中作用的项目数据不一致。大多数住院医师和小儿泌尿外科医生认为进行尿道下裂手术需要专门培训。
