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• W2018097130 abstract "The authors reported the results of the Byars two-stage hypospadias repair in 128 patients. This group comprised 25% of the patients who underwent repairs during 2009e2012. The group was defined by those patients who required transection of the urethral plate to correct chordee. The results reported are excellent and I congratulate the authors. However, I cannot help wondering if this group is similar to the patients I operate on and consider being severe. I also cannot help wondering how these patients will assess their repairs in 20-years time. An erection test was performed after penile degloving; it was repeated again after the plate was divided. It would have been helpful to see the authors report on the degree of chordee correction that occurred when the plane was divided, e.g. 65 e40 , and then when multiple transverse corporotomies had been performed, e.g. 40 e10 . Although this series was a subset of hypospadias repairs, defined by those patients who needed to have the urethral plate divided, it is difficult to know how severe the hypospadias was in these patients before it was repaired. Severe hypospadias makes up the minority of cases and the bad results for these cases are diluted out by the good results in the less-severe cases. If a patient has a good-sized phallus and a deep groove in the glans, then they will do better than a patient with a short phallus and a small, rounded glans. For future studies, randomisation that compares one technique to another, e.g. Byars flaps versus Bracka grafting, would be ideal. However, randomised studies are difficult for surgeons to organise for many reasons. We could also improve the reporting of single surgeon and unit series by moving to a preoperative objective measurement of the severity of hypospadias, e.g. GMS scoring [1] or preoperative photographs. We also need an objective measure of the functional and cosmetic outcome of the repair, and there have been several scoring systems published that measure these. Then we, the reader, can see what improvement there has been with the operation described. As surgeons, we seem to be struggling with severe proximal hypospadias cases and there is ‘hunting oscillation’ with a cycle of 20 years or so. As we see bad results, with one technique, after long-term follow up, we switch to a new technique in the hope that it will be better. Complications are always less with new techniques since the follow up is shorter. Hopefully the oscillations of the hunting are converging on a solution." @default.
• W2018097130 created "2016-06-24" @default.
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• W2018097130 date "2014-12-01" @default.
• W2018097130 modified "2023-09-25" @default.
• W2018097130 title "Commentary to ‘Byars two-stage procedure for hypospadias after urethral plate transect'" @default.
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• W2018097130 doi "https://doi.org/10.1016/j.jpurol.2014.05.005" @default.
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