concluded that early surgical correction is possible as tunica albuginea plication was also effective in prepubertal period.6,12 The two glanular hypospadias
cases, one is showed in Fig.4, were detected when the foreskin was retracted during circumcision.
We report here the prevalence of hypospadias from 1980 to 1999 in 20 regions of Europe with EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers, 14 of which implemented a guideline to exclude glanular hypospadias. We also report data from the England and Wales National Congenital Anomaly System (NCAS).
In 1990, the EUROCAT list of minor anomalies for exclusion (including glanular hypospadias) was implemented.
Among the registries implementing the guideline (Paris, Tuscany, Northern Netherlands, Basque Country, Odense), two registries found that some cases of glanular hypospadias had been incorrectly included among registered cases (11 of 47 cases of verified location in Paris, 2 of 17 in Basque Country).
Six of the 20 EUROCAT registers in our study were found not to be following the EUROCAT guideline to exclude glanular hypospadias. Lack of resources or reliable access to appropriate sources of clinical information on location of hypospadias led some registries not to implement the guideline and others to implement with varied success.
A further important reason mentioned by registries for not implementing the exclusion guideline was that the registry did not consider glanular hypospadias to be in fact minor, given that a large number of such cases were having corrective surgery.
Interestingly, in several of the 42 surgical procedures classified as category A by the RCPSC, a significant percentage of residents felt that their proficiency was not category A; the procedures included repair of urinary fistulae (82.1%), pediatric indirect hernia repair and meatal repair for glanular hypospadias
(67.9%), open pyeloplasty (64.3%), anterior pelvic exenteration (61.6%), open varicocelectomy (60.7%) and radical cystoprostatectomy (33.3%) (Table 2).