Enlarged Prostatic Utricle Associated to Hypospadias

However beautiful the strategy, you should occasionally look at the results. Winston Churchill This message cautions that one should not be so infatuated with the beauty of one’s design such that one fails to evaluate the outcomes. As has often been stated, in a surgical discipline with well over 200 described techniques, none can be universally applied or universally successful. In fact, the only uniformly successful hypospadias repair was that described by the Greek physicians Heliodorus and Antyllus, which was amputation of the penis distal to the hypospadiac meatus. The “bible” of genital surgery during my residency was written by a plastic surgeon, Charles Horton. It was entitled Plastic and Reconstructive Surgery of the Genital Area (1973). Dr. Horton was a gifted surgeon, however, he realized that surgery of the genitalia in children and particularly hypospadias, required expertise and techniques from across disciplines. He partnered with a urology colleague, Charles Devine, to bring together the two specialties in developing philosophies and techniques for correction of genital surgical anomalies. During my fellowship in Philadelphia, John Duckett guest edited an issue of the Urology Clinics of North of North America (1981) on hypospadias, in which he invited international experts to describe their favorite hypospadias repair. Here, he coined the term “hypospadiology,” signifying a distinct subject of study. This certainly holds true, as evidenced by the considerable amount of literature dedicated to this anomaly. As John pointed out in 1981, truly original contributions to hypospadias repair are rare; however, our literature is replete with modifications and alteration of techniques, in quest of the perfect result. To me, a successful hypospadiologist is one with a detailed understanding of the anatomy, meticulous surgical technique, and an appreciation for artistry. One must be flexible in the operating room and never be bound to a preoperatively determined technique, as during the course of a repair anatomical minefields are common. It is not sufficient to be facile with a couple of repairs, but instead be familiar with many different techniques as well as their various modifications, alterations, and nuances. A robust armamentarium is necessary to approach the multiple variances and complications of hypospadias. I often tell trainees and medical students that hypospadias is often what causes a pediatric urologist to become a pediatric urologist, and what causes an adult urologist to stay in adult urology