How to Identify an Expert in Hypospadias Surgery or Any Surgery?

‘Doctor, we took our child for hypospadias surgery to a big hospital, but unfortunately the operation has failed; Where did we make a mistake? How did we fail to identify the best surgeon for our child?’ This is a common question that many worried parents pose to me!!

How do parents choose the expert surgeon for hypospadias surgery (or for that matter any major surgery) for their child? This is a very difficult question to answer. We need to understand that even expert surgeons can have complications. However, in the hands of an expert surgeon, the chances of success are much higher, while complications are much less common and of less severe nature than in the hands of other surgeons with lesser expertise and experience. The expert surgeon not only knows how to minimise complications, but also how to successfully manage a complication when it occurs.

Hypospadias surgery is a very specialised operation which is unlike most other operations in surgical practice. The result of Hypospadias surgery has a life-long impact on the child and the family. Hypospadias surgery requires special interest and special skills/ training. But this alone is not sufficient. Most importantly, the surgeon should continue to do hypospadias surgery on a regular basis to maintain and improve his skills; it is roughly estimated that a minimum of 50 hypospadias operations per year must be performed by the surgeon to maintain his skill set! The major task for parents is to identify whether the surgeon they consulted for their child’s hypospadias surgery fulfils the criteria for a good hypospadias surgeon.

Here are a few tips that could help parents to assess the competence/expertise of the surgeon; although not fool-proof, these may apply as broad guidelines for the parents to choose the best surgeon for their child not only for hypospadias but also for other major operations:

1. The surgeon’s training background
2. Post-training experience of the surgeon
3. Evidence of the surgeon’s special interest in hypospadias surgery
4. Data or some proof that the surgeon performs this operation on a regular basis. If the surgeon or the hospital can provide some numbers, nothing like it.
5. Some data showing the results of hypospadias operations in the hands of the surgeon (the surgeon or the hospital could provide this data). Obtaining contact/references of some previous patients who had similar operations by the same surgeon will help immensely. Talking to someone who already underwent a similar operation by the surgeon can relieve the anxiety and give confidence to the parents.
6. Has the surgeon published any papers or publications in peer-reviewed national or international journals on this topic? These indicate that the surgeon has special interest on this topic, is serious with his work, maintains data and is well appraised of recent developments in the field.
7. Any books or book chapters written by the surgeon on the topic can be a useful indicator of his expertise  and experience.
8. Any new techniques/modified techniques or technology invented/discovered by the surgeon and published in peer-reviewed journals can be helpful.
9. Unfortunately, articles written in local newspapers cannot be used as a reliable indicator of expertise of the surgeon! Anyone can write such articles on any topic in local newspapers just by reading a book, and these articles are not peer-reviewed by experts in the field.
10. Many times, the parents may meet similar patients in the surgeon’s clinic and they may exchange their experiences! This may really help.

These are some of the points that the parents can keep in mind while they assess the expertise of the surgeon for their child’s hypospadias operation. The results of hypospadias surgery depend heavily (almost completely) on the expertise of the surgeon. Probably no other operation has such a direct link between the skill/expertise of the surgeon and success!! Over 90% of success in hypospadias surgery is dependent on surgeon’s expertise; only 5-10% result is determined by other factors like severity of the problem, the tissue healing (which varies from person to person), any post-operative infection, blockage of catheter during post-operative period, or any other unexpected problems. Hypospadias operation does not require expensive equipment (unlike laparoscopic or robotic surgery), major ICU care facilities or a big corporate set-up! Apart from surgical skill, all it requires is a clean operation theater, a few fine microsurgical instruments and fine suture materials. Apart from these, a good hypospadias surgeon always uses magnification during the surgery (called surgical loupes); there are many types of these, and the surgeon may be using whatever he may be most comfortable with.

I hope this blog is useful for the parents and has answered at least some of their queries. The only job of parents is to find the right surgeon for their child’s surgery. It is as simple (or as complicated!!) as that!!!