RECENT ADVANCES IN UNDERSTANDING /MANAGEMENT OF HYPOSPADIAS
By Warren Snodgrass MD and Nicol Corbin Bush MD, MCS
Hypospadias is the second most common birth difference, where the urinary opening is below the normal location at the tip of the penis. Usually the foreskin is only partially formed, and sometimes there is downward bending (“chordee”). Older boys and men with hypospadias can have spraying or deflection of their urine stream, and many have to sit to urinate (pee). Those with bending can have difficulties with sexual intercourse. The partial foreskin looks neither circumcised nor natural, and may cause embarrassment and self-esteem problems.
Hypospadias surgery began over 100 years ago. Over the years many improvements have been made in the surgical techniques, and in the overall management of these boys and men before and after surgery.
In this article Dr Snodgrass and Dr Bush describe their extensive work to help improve hypospadias surgery. The foundation of their progress is the PARC Urology database listing information on every patient they have cared for since 2000. This is now one of the largest databases in the world on hypospadias. They review this information frequently, to be certain they maintain a high success in hypospadias repair. They also use this data to learn more about how hypospadias surgery can be improved.
As this article discusses, they have among the best results in the world for distal and proximal hypospadias repairs, and reoperations for complications. They have also found that results of surgery are the same in adults as in children, which is important for adults, who have been told the chances for success in them is less, to know.
Sometimes testosterone is recommended before surgery to grow the penis larger. Dr Snodgrass and Dr Bush used this hormonal therapy for a period of time based on exact measurements of the head of the penis, and confirmed the penis enlarges with treatment. However, testosterone did not reduce complications from surgery, and, in fact, may have actually increased problems.
Most importantly, drawing on their large experience and careful quality review of their results, Dr Snodgrass and Dr Bush make recommendations for other pediatric urologists to improve their hypospadias surgery. One is for other surgeons to also review their personal results to know if they are achieving the best possible. It may come as a surprise to patients and care-givers that many surgeons do not know their own results, but instead assume they are similar to what other surgeons have published.
Another is that proximal hypospadias surgery, and reoperations, which are less common than distal hypospadias repairs and have greater risks for complications, should be done by pediatric urologists who actually specialize in hypospadias surgery- as do Dr Snodgrass and Dr Bush at PARC Urology. Currently, most pediatric urologists do only 2 or 3 of these complex operations each year, which is not enough to get the best results.
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