This article by Dr. Bush and Dr. Snodgrass reviews the STAG surgical techniques for the correction of “severe” hypospadias. Severe hypospadias is defined as hypospadias associated with more than 30 degrees of ventral (forward) curvature. This type of hypospadias is rare, happening in about 500 boys in the US each year. Complication rates after proximal hypospadias repair have recently been reported at more than 50% by several urology programs in the United States. We discuss the surgical technique and technical changes which helped us significantly improve outcomes for patients with severe hypospadias. All of the improvements in proximal hypospadias repair result from constantly reviewing our success rates. Each technical step in reconstructive surgery can have a major impact on success rates. In addition, at PARC Hypospadias Center, all reconstructive surgery is done by an experienced team of surgeons. Most pediatric urology programs do not have a team dedicated to complex hypospadias repair, and surgeons typically operate with a nurse or trainee. At PARC Hypospadias Center, we feel strongly that the first operation is the most important opportunity to achieve the best results.
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