Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center (preprint)

Background Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6-18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias.Methods We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children’s Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU guideline.Results A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1±16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR]=1.562; 95% confidence interval [CI]1.199-2.034; p=0.001), prostatic cyst (OR=2.613; 95% CI 1.579-4.324; p<0.001), penile hypoplasia (OR=1.778; 95% CI 1.225-2.580; p=0.002), inguinal hernia (OR=2.070; 95% CI 1.394-3.075; p<0.001), and penoscrotal transposition (OR=4.125; 95% CI 1.250-13.619; p=0.020) were more likely to receive delayed surgery. Living in a low economic area (OR=1.731; 95% CI 1.068-2.806; p=0.026) or not close to a main medical center (OR=1.580; 95% CI 1.370-1.824; p<0.001) was highly associated with delayed surgery. The proportion of children undergoing delayed surgery and the median age of surgery during the COVID-19 pandemic were significantly higher than those before the COVID-19 pandemic (p=0.004 and < 0.001, respectively).Conclusions Most children with hypospadias received delayed surgery (surgical age >18 months). Comorbidities, living in a low economic area, too far from a major city medical center and the COVID-19 pandemic were also highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery. Trial registration Not applicable. 

Impact of COVID-19 on health profession education in Singapore: Adoption of innovative strategies and contingencies across the educational continuum

Introduction: The Coronavirus-19 pandemic has had profound effects on health professions education (HPE) posing serious challenges to the continued provision and implementation of undergraduate, postgraduate and continuing medical education (CME). Across these HPE domains, the major disruptions included the exclusion of undergraduate learners from clinical learning environments, restricted intra-, inter-institutional and overseas movement of medical professionals, termination of face-to-face learner-educator interactions, deployment of postgraduate learners into non-scope service settings, and CME postponement. Methods: In this review we report on how in Singapore various adaptive measures were instituted across the 3 HPE domains at institutional and national level to maintain adequate resources at the frontline to meet service exigencies, promote healthcare professionals' wellbeing and safety as well as mitigate the spread of the pandemic. Results: We identified several strategies and contingencies developed to address these challenges. These involved the use of online learning platforms, distributed and asynchronous learning, an undergraduate Pathway Programme, and use of innovative hands-on technology like simulation. Robust, well pre-planned pandemic preparedness, effective communication, as well as provision of psychological support resources ensured maintenance of service and academic continuity, trust and resilience within HPE. However, several challenges remain, namely the timing and manner of conducting formative and summative assessments, cybersecurity, and the indispensable hands-on, in-person experiential learning for surgical training. Conclusion: Strong leadership with vision and planning, good communication, prioritising learners' and educators' wellbeing and safety, and harnessing existing and emerging online learning technologies are crucial elements for effective contingencies for HPE disruption during pandemics. [ABSTRACT FROM AUTHOR] Copyright of Asia Pacific Scholar is the property of Centre for Medical Education (CenMed) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)