TUBULARIZED INCISED PLATE PROXIMAL HYPOSPADIAS REPAIR: CONTINUED EVOLUTION AND EXTENDED APPLICATIONS
By Warren Snodgrass MD and Nicol Corbin Bush MD, MCS
TIP hypospadias repair is the most common surgery done for distal hypospadias around the world. Given the success of that operation, naturally the next question was how good would TIP be for proximal hypospadias surgery?
When Dr Snodgrass first started doing proximal TIP repairs, half his patients developed complications that needed another operation to fix. He discovered that by reviewing his results, and immediately set about to modify the surgical technique to improve it.
He was able to reduce those initial complications by 50%, and published specific technical changes explaining how to do the surgery better. Then he made additional modifications, and significantly reduced complications again.
Those technical changes are described for other pediatric urologists in this article. By these improvements, Dr Snodgrass and Dr Bush at PARC Urology have among the best results for proximal hypospadias surgery reported anywhere in the world.
Despite that, these hypospadias experts continue to work to do better. Dr Snodgrass and Dr Bush have learned there are patients who do best with a proximal TIP repair, and others with proximal hypospadias who are better treated with a 2-stage graft operation. These 2 techniques share many similarities, and the final results in their hands are the same.
The decision between TIP and 2-stage repair is made by how much penile curvature (“chordee”) the boy has. Those with little or no bending have a TIP hypospadias repair, while those with more bending have the 2-stage repair, which is also discussed in NEWS & ARTICLES on this PARC Urology website.
Similar improvements by technical modifications have been reported much less often with other surgical methods for proximal hypospadias, and even these 1 and 2- stage repairs done at major academic centers continue to have much higher reported complications, occurring in over 50% of boys.
So the surgical technique a surgeon uses to fix proximal hypospadias is important to the success of that repair. So is the number of proximal hypospadias surgeries a surgeon does each year. Since Dr Snodgrass and Dr Bush are hypospadias specialists at PARC Urology, they operate on many boys with proximal hypospadias each and every week. In contrast, most pediatric urologists do only 1 or 2 of these hypospadias surgeries each year. It is well known that the best results for complex operations come from surgeons who do them frequently, so care-givers and patients needing proximal hypospadias repair should seek out a skilled hypospadias team like Dr Snodgrass and Dr Bush to do the surgery.