The management of hypospadias: its relevance to surgical training in the principles and practice of plastic surgery

Abstract

The practice of specialist medicine demands expertise not only in the therapeutic manoeuvres routine to the discipline but also in analysis of the clinical problems encompassed by the speciality. Training aims to educate in the widest sense, achieving the competence in both which, practised with compassion, is the hallmark of a clinician. Following diagnosis, the need for medical intervention may be a difficult decision. If necessary, treatment should be carried out e~caciously: its intention, likely effects and possible complications should be clear. Surgery should be of meticulous design and be executed without undue risk to the patient. Follow-up may be brief or otherwise but should be sufficient to maintain the benefits of therapy and allow critical analysis of the treatment. The latter is essential not only to the well-being of the individual patient but also to that of those who follow, whether confined to the clinician’s own practice or in the wider sphere which follows dissemination of experience by teaching and writing. In practice the pursuit of such ideals is not easy, particularly in respect of those ailments for which treatment is complicated and not entirely satisfactory. Reappraisal of the philosophy of management of such conditions by successive generations is not only necessary to progress but also essential to the training of a new generation of specialists. The anatomical defect of hypospadias is clearly defined and diagnosis is usually evident. While complete failure of ventral fusion of the prepuce is a constant feature, the degree of chordee and meatal retroposition are both variable, giving rise to a spectrum of severity of this condition. Not many patients have an absolute indication for surgery : all can pass urine and few will be incapable of