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5 January 2012
Hypospadias procedure gets thumbs-up
by George Atkinson

A new technique to correct hypospadias (where the opening of the urethra is misplaced on the penis) has been shown to be less complicated than other procedures with the added benefit that it leaves the penis with a more natural appearance.

Warren Snodgrass, a pediatric urologist at UT Southwestern Medical Center who pioneered the surgical technique, recently analyzed results from eight years of performing the operation and reported the procedure is singularly effective in correcting the problem with few complications.

His findings, appearing in the Journal of Pediatric Urology, will offer significant reassurance to parents of infants suffering the genital defect. Hypospadias is the second most common birth defect in boys. If not corrected properly, it can lead to urinary tract infections and difficulty with urination and normal sexual activity in later life.

Snodgrass says the technique has a postoperative success rate of better than 95 percent. "Our data and patient outcomes proved that this technique is universally applicable for distal hypospadias, regardless of anatomy, which varies from patient to patient," he added.

Called tubularized incised plate (TIP) repair, the surgery can repair both distal and proximal hypospadias. Distal hypospadias means the opening to the urethra, or urethral meatus, is closer to the tip of the penis than proximal hypospadias, and is typically easier to repair. In both cases, TIP repair uses tissues that normally create the urinary channel, without the need for skin flaps, which had been commonly used for more than a century.

"Urinary flow appeared normal in our patient group, and we found that all forms of distal hypospadias can be corrected with good results," Snodgrass said. "The data is very encouraging and we hope it will decrease confusion about the circumstances in which the TIP procedure is applicable."

Interestingly, TIP repair for the more challenging proximal hypospadias reduced complications from 53 percent to 13 percent. Using skin flap techniques, the expected complication rate for proximal hypospadias remains more than 30 percent.

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Source: UT Southwestern Medical Center

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