Introduction: Considerable controversy exists regarding the optimal surgical technique for the repair of midshaft and proximal hypospadias. We sought to evaluate differences in surgical preferences among an international cohort of pediatric urologists.
Methods: An anonymous questionnaire, containing relevant demographic data as well as choices of technique to repair 5 representative hypospadias cases was developed and administered.
Results: 101/121 pediatric urologists completed the survey representing an 83% response rate. The majority were full-time academic pediatric urologists who performed ≥ 6-10 hypospadias surgeries/month. Most of the respondents, 92/101 (confidence interval (CI) 0.84-0.96), preferred the tubularized incised urethral plate technique (TIP) for the repair of distal hypospadias. Similarly the majority, 82/101 (CI 0.72-0.88), preferred TIP for the repair of midshaft hypospadias. The two most common techniques for repair of proximal hypospadias without chordee, both 43/101 (CI 0.33-0.53), were TIP and TVIF (transverse island flap) onlay. For repair of moderate (30-40°) chordee, preferred techniques were dorsal plication in 82/101, or a ventral approach in 12/101. When moderate chordee was associated, the most common techniques for hypospadias repair were TVIF onlay in 35/101 (CI 0.26-0.45) and TIP in 24/101 (CI 0.16-0.34). For severe chordee (>50°), 31/101 preferred dorsal plication while 68/101 chose some form of ventral repair. Proximal hypospadias associated with severe chordee is most commonly approached by a staged procedure in 37/101 or in a single stage (using TVIF tube) in 40/101 (CI 0.30-0.50). Using Spearman’s rank correlation coefficient, no significant correlations were identified between respondent practice demographics and choice of repair for each hypothetical hypospadias case.
Conclusions: We have demonstrated that, in this cohort of pediatric urologists, the majority prefers TIP to repair distal and midshaft hypospadiac defects. Significant variability exists for preferred technique for proximal hypospadias and chordee correction. These results support the need for prospective trials comparing techniques for the repair of proximal hypospadias.

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