Re: Shaping Parents, Shaping Penises: How Medical Teams Frame Parents' Decisions in Response to Hypospadias.

available at http://www.ncbi. nlm.nih. gov/pubmed/30054962 Editorial Comment: These authors examined how 2 different groups of health professionals frame the discussion around hypospadias surgery in medical and nonmedical ways. Semistructured interviews were undertaken with 32 health professionals, and excerpts of the conversations are provided in the results section. Research interviews took place with medical professionals who worked at 12 hospitals in Scotland, England and Sweden. Surgeons don’t usually read the psychology literature. This article is important because it shows the difference between how surgeons and nonsurgeons describe to parents the need for hypospadias repair. This article suggests that the decision to proceed or not with penile reconstruction is scripted in our own professional experiences. For example psychologists are more ready to offer a nonmedical pathway than surgeons. We should all read this article to appreciate our biases when speaking to parents of children with hypospadias. Douglas A. Canning, MD Renal Transplantation and Renovascular Hypertension Re: Outcomes in Third and Fourth Kidney Transplants Based on the Type of Donor D. Dabare, T. Kassimatis, J. Hodson, M. A. Khurram, G, Papadakis, G, Rompianesi, O. Shaw, N. Karydis, C. Callaghan, J. Olsburgh, N. Mamode, N. Kessaris and I. Loukopoulos Department of Nephrology and Transplantation, and Clinical Transplantation Laboratory, Viapath, Guy’s and St. Thomas’ NHS Foundation Trust, London and Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom Transplantation 2019; 103: 1494e1503. doi: 10.1097/TP.0000000000002428 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/30130325available at http://www.ncbi. nlm.nih. gov/pubmed/30130325 Editorial Comment: Increasingly patients require repeat transplantations, some as many as 3 to 5. The third transplant and beyond may yield lower graft survival. However, these procedures still carry a survival benefit compared to remaining on the wait list. These authors review experience in the United Kingdom and identify heterogeneity in outcomes. Overall patient survival was no different with increasing number of transplants. The death censored graft survival rate was inversely related to number of transplants. The HLA compatible living donor transplants performed the best, with lower graft survival rates for deceased donor transplants and the lowest for HLA incompatible transplants. These results make sense. Outcomes of the third transplant and beyond seem to depend on features of the donor and the medical/surgical complexity of the recipient. These findings make it challenging to apply sweeping generalizations to multiply repeated transplants. Compatible living donors should be pursued. However, as long there is a survival benefit with deceased donation and HLA incompatible transplant in this population, the practice remains justified. David A. Goldfarb, MD RENAL TRANSPLANTATION AND RENOVASCULAR HYPERTENSION 1087 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.