Foreskin preservation

When your little one is born with hypospadias, you’re faced with a ton of questions: When will I do the repair, who will do the repair, will my insurance cover the repair? How will I get through it all. Believe me, I’ve been there. You research everything you can find. But there’s not much out there. You’ll buy the one or two books that exist, and maybe join a forum or two. At the end of the day, much of the work and research will be up to you.

One of the most important decisions you’ll make is who will do the surgery and what is their experience with your child’s degree of hypospadias. My son was born with penoscrotal hypopspadias. I knew the skill of the surgeon would be critically important for us, as the risk of complications increases with the severity of the condition.

After an exhaustive amount of research, I settled on Dr. Warren Snodgrass. During our first 2 surgeries Dr. Snodgrass was Chief of Pediatric Urology at Children’s Medical Center (Dallas, TX) and Professor of Urology at UT Southwestern. Now he’s at his own practice, PARC Urology, with Dr. Nicol Bush. One of the reasons I chose Dr. Snodgrass was that he is internationally renowned for his version of hypospadias surgery, the Tubularized Incised Plate (TIP) technique, which most surgeons refer to as the Snodgrass Repair. Also, he is foreskin friendly, meaning his preference is to perform hypospadias surgery without amputating the prepuce (circumcision).  I do happen to believe in keeping the foreskin in tact except for when it’s medically necessary, as hypospadias is. However, given the importance of the foreskin, and my other son’s intact state, foreskin preservation was ideal to me. Since my son’s hypospadias was severe, he did have a hooded foreskin. What this means essentially is there is more foreskin bunched up on top and very little underneath. This meant we didn’t have a lot of foreskin to work with, and at the end of the day, I wanted my son’s penis to look, and function, as normal as possible.

The Foreskin-Friendly Approach

While some physicians in the US automatically circumcise during hypospadias surgery (this was the requirement of the first surgeon we consulted with at OHSU, with the reason being there’s less mess, Dr. Snodgrass provides foreskin reconstruction even in severe cases of hypospadias such as my son’s. He has a success rate of 95% and has helped boys and men who have endured dozens of previous failed operations and complications due to hypospadias surgery.

The fact that Dr. Snodgrass advocates for hypospadias surgery while keeping boys intact is significant because he is a leader among pediatric urologists and surgeons operating on boys with hypospadias. No other active surgeon has published more scholarly articles on hypospadias surgery than Dr. Snodgrass. No other method to repair hypospadias has been the subject of more publications than the Snodgrass repair. Surgeons travel from around the world to observe his repairs, and parents such as myself, travel from across the country and internally to have their sons’ surgeries performed by him. Dr. Snodgrass has taught and practiced in more than 20 countries throughout North and South America, Europe, the Middle East and Asia.

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