HYPOSPADIAS NEONATAL CLINICAL GUIDELINE. 1. Aim/Purpose of this Guideline. 2. The Guidance

Transcription

1 HYPOSPADIAS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline applies to all staff managing the initial care of infants born with hypospadias. It includes assessment and details of investigations and the referral process. 2. The Guidance 2.1 Background Hypospadias is incomplete development of anterior urethra. Chordee is ventral curvature of the penis. Incidence: 0.8% (with 8% being hereditary in father or siblings). 95% of hypospadias boys have a hooded foreskin Classification Anterior hypospadias (70%) Glanular (meatus situated on the inferior surface of the glans) Coronal (meatus situated in the balanopenile furrow) Anterior penile (meatus situated in the distal third of the shaft). Posterior hypospadias (20%) Posterior penile (meatus situated in the posterior third of the shaft) Peno-scrotal (meatus situated at the base of the shaft in front of the scrotum) Scrotal (meatus situated on the scrotum between the genital swellings) Perineal (meatus situated behind the scrotum and behind the genital swellings). Page 1 of 9

2 2.3 Management Document the position of the hypospadias and any associated chordee, as well as the descent of the testes. Eamine for other uro-genital abnormalities. Advise the parents about the need to avoid circumcision. Assess urine stream while in hospital. An isolated hypospadias which is glanular, coronal or anterior penile (the meatus is on the distal one third of the shaft of penis) or middle hypospadias where the meatus is on the middle aspect of the penis then no endocrine, chromosomal or imaging investigations are required provided there are normally descended testes. Referral should be made for Plastic Surgery assessment (we advise the GP to make the referral) when the hypospadias is first identified so that an early assessment can be made, surgery planned, and parents counselled on prognosis, including outcomes and possible complications of surgery. Surgery is usually carried out at around 12 months of age and may involve a single operation or a two-stage procedure, depending upon the severity. Children will be seen locally but surgery will be carried out at Derriford. However children with posterior hypospadias which is either on the proimal third of the shaft or peno-scrotal or scrotal or perineal with or without other abnormalities should be seen and discussed with a neonatal consultant (assessing for a comple urological condition, or an interse condition, where various investigations will be needed) Currently referrals are made to : Mr D Mackenzie Consultant Plastic Surgeon Derriford Hospital Derriford Road Derriford PLYMOUTH PL6 8DH In line with commissioning policy the referral should be made by the GP. The secretaries will send out a standard letter to the GP which needs medical details adding. Appendi 3 More complicated urological anomalies may need to be referred to Mr Nicholls Bristol based Paediatric Urologist. Page 2 of 9

3 Summary of Actions - Simple hypospadias 1. Thorough eamination. 2. Referral to Plastic Surgeon via GP [standard letter (in Appendi) with secretaries] 3. Fill out South West Congenital Malformation Register form (via NNU data co-ordinator or midwife). Summary of Actions - comple hypospadias 1. Consultant paediatric review 2. Consider need for further investigations 3. Consider Paediatric urology/endocrine referral Page 3 of 9

4 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Key changes in practice Dr Paul Munyard. Consultant Paediatrician and Neonatologist Audit. To be included in the Neonatal clinical Audit Programme. Findings reported to the Directorate Audit meeting / Governance meeting. Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared As dictated by audit findings Child Health Directorate Audit and Clinical Guidelines meetings. Dr Paul Munyard. Consultant Paediatrician and Neonatologist Required changes to practice will be identified and actioned within 3 months of audit. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders. 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendi 2. Page 4 of 9

5 Appendi 1. Governance Information Document Title Hypospadias Neonatal Clinical Guideline Date Issued/Approved: February 2015 Date Valid From: February 2015 Date Valid To: February 2018 Directorate / Department responsible (author/owner): Paul Munyard Consultant Paediatrician and Neonatologist. Neonatal. Child Health Contact details: Brief summary of contents This guideline is designed to provide guidance on the management of an infant diagnosed with hypospadias Suggested Keywords: Target Audience Eecutive Director responsible for Policy: Neonatal. Hypospadias. Chordee. Male genitalia RCHT PCH CFT KCCG Eecutive Director Date revised: November 2014 This document replaces (eact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Assessment and management of hypospadias Neonatal consultants. Child Health Audit and guidelines meetings Sheena Wallace Name and Post Title of additional signatories Signature of Eecutive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Not Required {Original Copy Signed} Internet & Intranet Intranet Only X Page 5 of 9

6 Document Library Folder/Sub Folder Links to key eternal standards Related Documents: Training Need Identified? Neonatal South West Cleft Team Standards Bristol Children s Hospital No No Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) 22:01:2015 V1.0 Formatted and approved Paul Munyard. Consultant Paediatrician and neonatologist All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of epiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the epress permission of the author or their Line Manager. Page 6 of 9

7 Appendi 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Directorate and service area: Is this a new or eisting Policy? Child Health. Neonatal New Name of individual completing assessment: Paul Munyard 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? 2. Policy Objectives* As above Telephone: To provide guidance on the management of an infant born with hypospadias 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Evidence based practice Audit Neonatal / Midwifery medical and nursing staff Infants and their carers No. Neonatal Guidelines Group consultant approved guideline. b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Eisting Evidence Age Page 7 of 9

8 Se (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Seual Orientation, Biseual, Gay, heteroseual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this ecludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes 9. If you are not recommending a Full Impact assessment please eplain why. Signature of policy developer / lead manager / director Paul Munyard 22 January 2015 Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Kim Smith Date 6th March 2015 Page 8 of 9

9 Appendi 3 Standard Letter to GP Dear Re: Baby. This baby has hypospadias/ chordee/ and will therefore need referral to the Plastic Surgeons at Derriford Hospital. Whilst referral is not urgent, we would recommend referral as soon as possible to allow for assessment, parental counselling, and planned surgery around 12 months of age, in line with the surgeons recommendations. Circumcision must be avoided. In line with commissioning requirements, all such referrals need to come from the GP rather than the Paediatricians. Yours Page 9 of 9