It is clearly reflected in the literature where one can find a plethora of techniques that have been described with each adding to the armamentarium of penile and urethral reconstruction with a success rate equaling each other. Drs. Horowitz and Salzhauer showed Dr. Horowitz's learning curve in regards to hypospadias repair from the completion of fellowship training in pediatric urology to five years after that training.

The group prospectively collected data on 231 consecutive hypospadias operations performed by Dr. Horowitz over that 5-year period. All patients were having their first surgery and none were a staged repair. Fistula formation was used as the cornerstone of complications. The rationale was that it is an objective measurable outcome that is easily identified with little interobserver or parental/physician variability. The follow-up included several visits in the 15 months after repair, during which virtually all complications could be identified and addressed.

They found that the operative results improved throughout the 5 years of observation. They noted that there was a statistically significant decline in the fistula rate in each year of observation (P < 0.001; Kruskal-Wallis exact test for ranked groups). The absolute reduction in fistula rates between the first 2 and the last 2 years was 12.7% (P < 0.02; chi squared). With this data they concluded that even though one is a fellowship-trained pediatric urologist, hypospadias surgery statistically improves with time and experience. Well done.

BJU Int. 2006 Mar;97(3):593-6

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