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Is hypospadias surgery taught during the residency program in France?

J. Rod, t. Petit, P. Ravasse
Department of Pediatric Surgery and Urology, CHU Caen, France



Objective: Hypospadias surgery is delicate, a source of complications, intimately linked to the operator’s experience. This act is becoming predominant in pediatric urological surgery. In order to find out how its practice was taught in university clinics of pediatric surgery, we carried out a survey of the “chiefs de clinique-assistant (CCA)” , chief fellow, of pediatric surgery in France.
Material and methods: All pediatric urologic surgery university clinics in France that had a CCA in training (17), specializing in visceral and urologic pediatric surgery were contacted. A questionnaire was sent to all senior referents of pediatric urology in their clinic (22) and also to their CCA (27). The questionnaire was about the participation of the CCA in the practical stages of this surgery, the existence of a fellowship, the number of children operated by the CCA, their personal recruitment and their vision on the formation at the end of the residency.
Results: 12 senior referents (54%) and 18 CCA (66%) responded. The answers were similar within the same clinic, apart from the number of interventions performed in partnership senior-CCA, estimated at 50% by the senior versus <25% by the CCA. The fellowship exists for almost all the participants. The drawing of the intervention is the least performed stage by the CCA and the number of stages increases with the experience of the CCA. 2.8 children with hypospadias per year of residency are operated on average by each CCA. The answer of the CCA about the resented quality of their formation does not depend on the expertise of the centre or on the number of seniors practicing this surgery. It seems to depend on their personal experience and on the total number of children operated.
Conclusion: Hypospadias surgery is mostly performed by the referent. The fellowship system exists, but, taking into consideration the average number of cases operated by a CCA each year, it seems highly improbable that they are actually formed at the end of their residency.


Key words: hypospadias surgery, operator’s experience