Eur J Plast Surg (2004) 27:213 DOI 10.1007/s00238-004-0627-9 BOOK REVIEW C. R. J. Woodhouse Edited by A.T. Hadidi and A.F. Azmy: Springer, Berlin, 2004 Published online: 20 May 2004 Springer-Verlag 2004 It would be usual for an author to declare conflicting principles for appropriate cases. It is fascinating to read interests at the end of an article. However, where a eulogy that the technique of intra operative artificial erection was is about to be printed, it seems correct to make such a only described in 1974. It is amazing that any operation declaration at the beginning. Your reviewer wrote one of before this date could have been anything but a failure. the chapters in this book. If I did wish for more from the operative section, it It might be considered surprising that it should be would be a chapter on when not to operate. Is it always necessary to produce a book of 347 pages on the con- necessary to correct a very distal hypospadias when even struction of a tube that is usually less than 20 mm long the simplest operation has a complication rate of 1.2– for a largely cosmetic indication. Those who believe this 10%? Surgeons with a large practice in hypospadias will should either refrain from operating on cases of hypos- be aware of the standard debates: to stent or not to stent; padias or read this book in detail. to use a flap or a free graft; to dress or not to dress; one Those who wish to add to the 212 named operations stage or two stage? Each of these is covered in its own for hypospadias must first read the opening section (32% chapter. Not surprisingly, no conclusions are drawn be- of the book). Here it will be discovered that their opera- cause there is no ‘right’ answer. In their comment chapter, tion probably is not new. The principle of a tube with the editors do not attempt to advise but refer readers to the incomplete epithelial cover which is a major component appropriate section. of the currently favoured Snodgrass procedure, was de- Finally, you come to the complications and late se- scribed by Duplay in 1880. Sometimes the positioning of quelae. It is entirely appropriate that this section should be two extra sutures constitutes a named operation, as in the nearly as long as the operative section. Barry O’Donnell Arap modification of the MAGPI. is quoted as saying that any surgeon with no complica- More importantly, however, this section covers the tions is a liar. The complications are legion and their embryology, vascular anatomy, anaesthesia and psycho- correction is of the utmost importance so that a minor logical effects of infantile surgery knowledge of which is problem is not converted into ‘hypospadias cripple’. critical to a successful outcome. The surgical techniques There are number of important associated features (section 2) are beautifully illustrated. Indeed it is sur- whose surgery is within this section, notably the buried prising that, in a text that relies so heavily on the quality penis and transposition of the scrotum. One of the debates of illustrations, the illustrators are given so little credit: that is not considered in the text, but is inherent in the you have to look at the end of the authors’ preface to find author list, is whether hypospadias surgery should be done their names. The editors have resisted the temptation to by plastic surgeons or by paediatric urologists (never let it have a chapter on every single operation. Instead, they be said that a general urologist should be allowed even to have concentrated on descriptions of the main groups of examine a case let alone operate on it). The principles are surgical techniques. described by the plastic surgeons and the surgery by the In this section (and throughout the book) the choice of urologists. Many of the modern pioneers have been plastic authors has been very thoughtful. They have not chosen, surgeons. Perhaps the most successful reconstructors of in general, the original descriptors of operations (even the genitalia were Horton and Devine, who showed that where they are still alive). Most are known for their both skills together could do better than either alone. John excellent surgery and a critical ability to use appropriate Duckett quite rightly pointed out that the study of hy- pospadias is a science on its own. The surgery should be C. R. J. Woodhouse ( ) performed by hypospadiologists. I would suggest that The Institute of Nephrology and Urology, Gower Street Campus, surgeons should not operate on a patient with hypospadias University College, unless they have read, marked, learnt and inwardly di- 48 Riding House Street, London, W1P 7PN, UK gested every word in every chapter of this book. e-mail: firstname.lastname@example.org
European Journal of Plastic Surgery – Springer Journals
Published: Aug 1, 2004
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