Urologic conditions spread
Dr. Snyder says hypospadias repair and UDT are among the issues that are likely to become even more important in the future because they’re part of a larger group of urologic conditions that seems to be on the rise. “We used to think hypospadias affected about 1 in 300 live births, and now it seems to affect about 1 in 100; at the same time the incidence of UTD has doubled, from 1% to 2% of males,” Dr. Snyder says. “There has also been a drop in adult male fertility and a rise in testicular malignancy in adult men.”
Dr. Snyder believes that manmade chemicals may be at the root of the problem. “I am a consultant with a group that’s been looking into the concept of man-made chemicals having hormonal effects,” he says. “A lot of them are contained in pesticides, fertilizers, and plastics. This is an area where there’s lots of controversy,” he adds, “but I’m convinced that these chemicals are to blame.”
While a number of urologic problems may be growing, progress also is being made toward solving them. At this point, Dr. Snyder thinks that minimally invasive surgery and tissue engineering are among the most promising developments.
Although he only performs traditional open surgery, Dr. Snyder is a big fan of laparoscopy and robotic surgery for some pediatric patients. “We want to lessen the amount of suffering we put people through,” he says, “and the minimally invasive approach, whether you’re using a laparoscope or the robotic technique, enables you to create a lot less muscular discomfort. What mostly causes discomfort after any kind of surgical procedure is what you must do to gain access,” he explains. “What we do on the inside doesn’t necessarily cause trouble, but making a big excavation through someone’s abdominal wall in order to get to the problem sure does hurt!”
It was during a trip to Detroit several years ago that Dr. Snyder saw how effective minimally invasive surgery could be. While there, he had the chance to watch surgeon Mani Menon, MD, of the Vattikuti Urology Institute at Henry Ford Hospital, perform a robotic radical prostatectomy. “When I saw how effectively it worked and what you could do with the robotic control arms, I came back here and said to my partners, ‘Guys, I’ve seen tomorrow.’”
Although Dr. Snyder was instrumental in bringing robotic surgery to CHOP, he cautions that it is not appropriate for every pediatric patient. “I think people sometimes over-apply the use of minimally invasive techniques in infancy,” he says. “In very small children everything is measured in millimeters, and the amount of muscular discomfort we create in a baby or toddler is small.” The biggest advantage of minimally invasive surgery is seen in older children, such as a seven-year-old or a 15-year-old who needs to have a kidney removed. In these cases, he says, “you can certainly lessen their suffering with minimally invasive surgery.”