Pediatric Urology Academy

Amin Afrasiabi, MD, Pediatric Urologist
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Pediatric Urology Academy is an evidence-based educational podcast hosted by Amin Afrasiabi, MD, Pediatric Urologist. Each episode explores pediatric urology through clinical cases, landmark studies, practical decision-making, surgical principles, and emerging research. Topics include posterior urethral valves, vesicoureteral reflux, hydronephrosis, UPJO, megaureter, neurogenic bladder, hypospadias, disorders of sexual development, pediatric stone disease, and reconstructive surgery. Designed for pediatric urologists, urologists, residents, fellows, and healthcare professionals worldwide.

  1. 4d ago

    Long-Term Adult Outcomes After Childhood Hypospadias Repair

    Hypospadias surgery is usually performed in infancy, but the most meaningful outcomes may not appear until adolescence or adulthood. This episode asks a difficult question: are pediatric urologists declaring success before the patient has reached the age when success truly matters? We discuss puberty, recurrent curvature, urinary stream, strictures, spraying, penile appearance, body image, sexual confidence, fertility anxiety, partner perception, and why adult follow-up changes how we should judge childhood repair. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  2. 5d ago

    Cosmetic versus Functional Success: Are We Measuring the Right Outcome?

    A hypospadias repair may look successful in the postoperative photograph and still fail the patient later. This episode asks whether cosmetic success, anatomic success, urinary success, and patient success are the same outcome. We discuss HOSE, PPPS, urinary stream, meatal position, glans shape, uroflow, parent satisfaction, surgeon satisfaction, adolescent perception, body image, sexual confidence, and why short-term pediatric follow-up may miss the outcomes that matter most. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  3. 6d ago

    Redo Hypospadias: When the Tissue Has Already Lost Trust

    Redo hypospadias is not primary hypospadias repeated. The anatomy may look familiar, but the biology has changed. Scar, altered vascularity, consumed dartos, stiff glans wings, recurrent curvature, strictures, diverticula, fistulas, and prior tissue choices all change the operation. This episode reframes redo hypospadias as a different reconstructive disease. We discuss a five-failure framework: flow failure, tissue failure, coverage failure, curvature failure, and expectation failure. The goal is not simply to close the visible defect. The goal is to understand why the previous repair failed before creating the next repair. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  4. Aug 12

    Preventing Fistula: Dartos, Tunica Vaginalis, Coverage Layers, and Pressure

    Urethrocutaneous fistula after hypospadias repair is often described as an unpredictable complication. This episode argues the opposite. Fistula is usually the visible endpoint of pressure, ischemia, tension, distal obstruction, hematoma, catheter stress, or inadequate vascular coverage. We discuss dartos, tunica vaginalis, second-layer coverage, non-overlapping suture lines, glans pressure, dressing strategy, catheter-related stress, bladder spasms, distal narrowing, and why fistula prevention should be understood as engineering rather than luck. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  5. Aug 11

    Grafting in Hypospadias: Preputial Skin, Buccal Mucosa, and Tissue Trust

    Grafting in hypospadias is often discussed as a choice between tissues: preputial skin, buccal mucosa, local skin, extragenital tissue, free graft, or vascularized flap. This episode argues that the real question is not which graft is available. The real question is whether the graft can be trusted in the recipient bed where it is placed. We discuss preputial skin, buccal mucosa, graft take, graft contraction, inlay grafts, staged grafting, graft beds, corporotomy fields, tubularization timing, and why graft choice should be documented as a response to a defined tissue problem. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  6. Aug 10

    TIP After Three Decades: Why the Most Familiar Operation Still Fails

    The tubularized incised plate repair changed hypospadias surgery. It respected native tissue, avoided flaps in many distal repairs, produced a more vertical meatus, and became the most familiar operation in modern hypospadiology. But familiarity can be dangerous. This episode asks a more precise question: when does TIP stop being plate preservation and become a forced tube? We discuss urethral plate quality, glans configuration, distal calibration, proximal TIP, flow resistance, barrier layers, and why the operative note should document not only that TIP was performed, but why the plate deserved to be preserved. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  7. Aug 9

    Timing of Hypospadias Surgery: Why the Calendar Is Not the Surgeon

    Hypospadias timing is often reduced to a simple age window: six months, twelve months, eighteen months. This episode argues that timing is not only a calendar decision. It is a readiness decision. We discuss the four clocks that should guide surgical timing: anesthesia readiness, tissue readiness, phenotype readiness, and family readiness. The episode focuses on how timing changes in distal versus proximal hypospadias, why staged repairs must be planned as a sequence, when endocrine evaluation should come before reconstruction, and why the “standard age window” should not replace expert surgical judgment. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction.

  8. Aug 8

    STAG versus STAC in Proximal Hypospadias

    STAG and STAC are not simply two-stage versus three-stage repairs. They represent two different ways of sequencing wound healing in severe proximal hypospadias. In STAG, curvature correction, urethral plate transection, ventral corporal lengthening, and graft placement occur in the first stage. In STAC, straightening and shaft closure occur first. Grafting is delayed. Tubularization is delayed again. This episode reframes STAG versus STAC as a question of biological timing: which wound should heal first, and which wound should not be overloaded? We discuss ventral corporotomies, graft take, graft contracture, glans configuration, repeat artificial erection, tubularization readiness, and why operative documentation should describe the healing problem rather than only the named technique. This episode is part of Season 4 of Pediatric Urology Academy: Hypospadias — Anatomy, Judgment, and Reconstruction. Evidence basis: Campbell Chapter 56 describes STAG as a Bracka modification involving plate division, glans bed creation, graft quilting, compression, later tubularization, and warns that grafts placed over corporotomies may contract; it also describes STAC as delaying graft placement until after straightening and closure. Recent STAG-versus-STAC reports and reviews describe lower graft and urethroplasty complications with STAC in expert-center experience, but the evidence remains non-randomized and center-dependent. A 2026 JPU paper also evaluates three corporotomies during STAC for severe curvature, reinforcing the technical importance of repeated artificial erection and curvature verification.

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About

Pediatric Urology Academy is an evidence-based educational podcast hosted by Amin Afrasiabi, MD, Pediatric Urologist. Each episode explores pediatric urology through clinical cases, landmark studies, practical decision-making, surgical principles, and emerging research. Topics include posterior urethral valves, vesicoureteral reflux, hydronephrosis, UPJO, megaureter, neurogenic bladder, hypospadias, disorders of sexual development, pediatric stone disease, and reconstructive surgery. Designed for pediatric urologists, urologists, residents, fellows, and healthcare professionals worldwide.

Information

  • Creator
    Amin Afrasiabi, MD, Pediatric Urologist
  • Years Active
    2026
  • Episodes
    47
  • Rating
    Explicit
  • Copyright
    © Amin Afrasiabi, MD, Pediatric Urologist
  • Show Website
    Pediatric Urology Academy