TIP HYPOSPADIAS REPAIR: A PEDIATRIC INDICATOR OPERATION
By Warren Snodgrass MD and Nicol Corbin Bush MD, MCS
The TIP operation created by Dr Warren Snodgrass is the most common hypospadias repair used by surgeons around the world. 20 years after he published the first article, Dr Snodgrass and Dr Bush wrote this update to describe the evolution of the operation, and discuss the lessons they have learned which help improve all hypospadias surgery.
Central to their progress is their systematic collection of information on every patient they care for with hypospadias. This information is stored in the PARC Urology database, which is one the of the largest in the world. Dr Snodgrass and Dr Bush review this data frequently, to be certain they continue to have among the best results from hypospadias repair in the world, and to look for new ways to improve.
Dr Snodgrass started that database when he moved to Dallas in 1999, and has kept it current ever since. Dr Bush started working with him a few years later, and she improved the spreadsheet to facilitate more advanced statistical analysis of the information. This led them to new discoveries, such as the fact that the size of the head of the penis makes a difference in the results of hypospadias surgery. With that knowledge, she and Dr Snodgrass made new improvements in their operations to overcome the effect of size of the head, and recorded that information into their PARC Urology database. Soon they learned these changes were successful.
There is much interest worldwide in assessing the results of many types of operations and the surgeons who do them. In this article, Dr Snodgrass and Dr Bush propose hypospadias repair as an “indicator” operation for pediatric urologists. They suggest that all surgeons doing hypospadias repairs simply review their personal results, and then make improvements to achieve the best outcomes. Because proximal hypospadias repairs and reoperations for complications are less common and more demanding, with greater chances for problems afterwards, they also propose these hypospadias surgeries be done by pediatric urologists who specialize in hypospadias repair, as they have done at PARC Urology.
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