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RATIO OF PROSTATE SPECIFIC ANTIGEN
194
LETTERS TO THE EDITOR
the second stage is not through the “urethral plate” but through skin, and it remains to be seen if skin incisions will heal reliably without stricture. Finally, like the authors, I have also noted occasional glans dehiscence. Details of their technique for glanuloplasty might have been helpful to understand this complication, as in my experience it occurred following 1-layer closure with chromic catgut sutures and has been reduced by use of 2-layer closures with subepithelial polyglactin as the first layer. Presumably, longer lasting suture and layered approximation protect against this occurrence. Nevertheless, the authors should be congratulated for increasing awareness of this technique for staged hypospadias surgery. Many surgeons have been convinced that flaps inherently must be superior to grafts but this bias may relate to the tendency to tubularize grafts for 1-stage repair and a general lack of experience with the staged graft approach. The beauty of staging the graft procedure, as the authors stated, is the nearly complete assurance the graft will take, which means the tissues are well vascularized at the second stage for urethroplasty. Furthermore, as the authors emphasize, the reward for 2 operations is a penis that looks normal.
Respectfully, Warren T. Snodgrass Pediatric Urology, Division of Urology University of Texas Southwestern Medical School at Dallas 6300 Harry Hines Blvd., Suite 1401 Dallas, Texas 75235 DOI: 10.1097/01.ju.0000069501.26242.ef
ERRATUM RATIO OF PROSTATE SPECIFIC ANTIGEN Volume 169, Number 1, page 121: The name of the second listed author of this article is Toshiyuki Kamoto.
LETTERS TO THE EDITOR
the second stage is not through the “urethral plate” but through skin, and it remains to be seen if skin incisions will heal reliably without stricture. Finally, like the authors, I have also noted occasional glans dehiscence. Details of their technique for glanuloplasty might have been helpful to understand this complication, as in my experience it occurred following 1-layer closure with chromic catgut sutures and has been reduced by use of 2-layer closures with subepithelial polyglactin as the first layer. Presumably, longer lasting suture and layered approximation protect against this occurrence. Nevertheless, the authors should be congratulated for increasing awareness of this technique for staged hypospadias surgery. Many surgeons have been convinced that flaps inherently must be superior to grafts but this bias may relate to the tendency to tubularize grafts for 1-stage repair and a general lack of experience with the staged graft approach. The beauty of staging the graft procedure, as the authors stated, is the nearly complete assurance the graft will take, which means the tissues are well vascularized at the second stage for urethroplasty. Furthermore, as the authors emphasize, the reward for 2 operations is a penis that looks normal.
Respectfully, Warren T. Snodgrass Pediatric Urology, Division of Urology University of Texas Southwestern Medical School at Dallas 6300 Harry Hines Blvd., Suite 1401 Dallas, Texas 75235 DOI: 10.1097/01.ju.0000069501.26242.ef
ERRATUM RATIO OF PROSTATE SPECIFIC ANTIGEN Volume 169, Number 1, page 121: The name of the second listed author of this article is Toshiyuki Kamoto.