Document:

EXHIBIT 4.3.2

                                 AMENDMENT NO.1

                                       TO

                              AMENDED AND RESTATED
                         REGISTRATION RIGHTS AGREEMENT

      AMENDMENT NO. 1 to the Amended and Restated Registration Rights Agreement,
dated as of June 26, 1998 (the "Amendment"), by and among United Surgical
Partners International, Inc., a Delaware corporation (the "Company") and the
parties named at the foot hereof (each of such parties being hereinafter
referred to individually as a "Purchaser" and collectively as the "Purchasers"),
amending the Amended and Restated Registration Rights Agreement dated as of
April 30, 1998 among the Company and the several signatories thereto (the
"Registration Rights Agreement").

      On the date hereof, the Company and the Purchasers are consummating the
transactions contemplated by the Securities Purchase Agreement dated as of the
date hereof (the "Securities Purchase Agreement") pursuant to which the Company
has agreed to sell to the Purchasers an aggregate 400,000 shares of the
Company's Class A Common Stock, $.01 par value ("Class A Common Stock") (such
shares of Class A Common Stock being hereinafter collectively called the
"Shares").

      It is a condition to the closing of the transactions contemplated by the
Securities Purchase Agreement that the Company and the Purchasers execute this
Amendment.

      Pursuant to Section 13(d) of the Registration Rights Agreement, the
Registration Rights Agreement is hereby amended as follows:

      1. Each Purchaser is hereby made a party to the Registration Rights
Agreement with the same rights and obligations as a holder of "Investor Shares"
(with respect to the Shares) as set forth in the Registration Rights Agreement.

      2. The Registration Rights Agreement, as amended by this Amendment, is
hereby in all respects confirmed.

      3. This Amendment shall be governed by and construed in accordance with
the laws of the State of Delaware.
<PAGE>
      4. This Amendment may be executed in two or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute
one and the same instrument.

                               UNITED SURGICAL PARTNERS
                               INTERNATIONAL, INC.

                               By /s/ DONALD STEEN
                                      Donald Steen
                                      Chief ExecutiveEXHIBIT 4.3.3

                                 AMENDMENT NO.2

                                       TO

                              AMENDED AND RESTATED
                          REGISTRATION RIGHTS AGREEMENT

      THIS AMENDMENT NO. 2 to the Amended and Restated Registration Rights
Agreement, dated as of July 31, 1998 (the "Amendment"), is entered into by and
among United Surgical Partners International, Inc., a Delaware corporation (the
"Company"), and the parties named at the foot hereof (each of such parties being
hereinafter referred to individually as a "Purchaser" and collectively as the
"Purchasers"). amending the Amended and, Restated Registration Rights Agreement
dated as of April 3O, 1998, as amended among the Company and the several
signatories thereto (the "Registration Rights Agreement").

      On the date hereof, the Company and Health Horizons, Inc. ("HHI"), a
Delaware corporation in which Purchasers own stock, are consummating the
transactions contemplated by the Agreement and Plan of Reorganization, dated as
of July 29, 1998 (the Merger Agreement"), pursuant to which HHI will merge into
the Company, resulting in the issuance to the Purchasers of certain shares of
the Company's Class A Common Stock, par value $.01 per share ("Class A Common
Stock") (such shares of Class A Common Stock issued to the Purchasers, either as
a result of said merger or upon any conversion of shares of the Company's Series
B Convertible Preferred Stock, par value $.01 per share, issued to the
Purchasers in said merger, being hereinafter collectively called the "Shares").

      It is a condition to the closing of the transactions contemplated by the
Merger Agreement that the Company and the Purchasers execute this Amendment.

      Pursuant to Section 13(d) of the Registration Rights Agreement, the
Registration Rights Agreement is hereby amended as follows:

      1. Each Purchaser is hereby made a party to the Registration Rights
Agreement with the same rights and obligations as a holder of "Investor Shares"
(with respect to the Shares) as set forth in the Registration Rights Agreement.

      2. The Registration Rights Agreement, as amended by this Amendmen4 is
hereby in all respects confirmed.

      3. This Amendment shall be governed by and construed in accordance with
the laws of the State of Delaware.

<PAGE>
      4. This Amendment may be executed in two or more counterparts, each of
which shall be deemed an origina1. but all of which together shall constitute
one and the same instrument.

                               UNITED SURGICAL PARTNERS
                               INTERNATIONAL, INC.

                               By /s/ DONALD STEEN
                                      Donald Steen
                                      Chief Executive Officer

                                   PURCHASERS

   /s/ EDWARD W. KARRELS                         /s/ CHARLES MORTON
       Edward W. Karrels                             Charles Morton

  /s/ MICHAEL W. BARTON                          /s/ CHARLES McKAY
      Michael W. Barton                              Charles McKay

 /s/ JEFFREY L. STOCKARD            /s/ JEFF GAW Attorney in Fact for David Gaw
     Jeffrey L. Stockard                               David Gaw

   /s/ ALICE J. CHARRON                        /s/ SANDRA HOLSHOUSER
       Alice J. Charron                            Sandra Holshouser

                                      -2-EXHIBIT 4.3.4

                                 AMENDMENT NO. 3

                                       TO

                              AMENDED AND RESTATED
                          REGISTRATION RIGHTS AGREEMENT

      AMENDMENT NO. 3 to the Amended and Restated Registration Rights
Agreement, dated as of October 26, 1998 (the "Amendment"), among United
Surgical Partners, International, Inc., a Delaware corporation (the "Company")
and the several other parties named at the foot hereof, amending the Amended
and Restated Registration Rights Agreement dated as of April 30, 1998 among the
Company and the several signatories thereto (the "Registration Rights
Agreement"). All capitalized terms used and not defined herein shall have the
meaning set forth in the Securities Purchase Agreement dated as of the date
hereof (the "Securities Purchase Agreement") among the Company and the several
other parties named therein.

      On the date hereof, the Company and the Purchasers are consummating the
transactions contemplated by the Securities Purchase Agreement pursuant to which
the Company has agreed to sell to the Purchasers from time to time an aggregate
9,157,356 shares of the Company's Class A Common Stock, $.01 par value ("Class A
Common Stock").

      It is a condition to the closing of the transactions contemplated by the
Securities Purchase Agreement that the Company and the parties hereto execute
this Amendment.

      Pursuant to Section 13(d) of the Registration Rights Agreement, the
Registration Rights Agreement is hereby amended as follows:

      1. Each WCAS/HC Purchaser, other than Tucker Taylor, Alyce Craddock, Greg
Koonsman and Jon O'Sullivan, is hereby made a party to the Registration Rights
Agreement with the same rights and obligations as a holder of "Restricted Stock"
(with respect to the shares of Class A Common Stock purchased by such WCAS/HC
Purchaser pursuant to the Securities Purchase Agreement) as set forth in the
Registration Rights Agreement.

      2. Each Management Purchaser, Tucker Taylor, Alyce Craddock, Greg Koonsman
and Jon O'Sullivan is hereby made a party to the Registration Rights Agreement
with the same rights and obligations as a holder of "Investor Shares" (with
respect to the shares of Class A Common Stock purchased by such individual
pursuant to the Security Purchase Agreement) as set forth in the Registration
Rights Agreement.

<PAGE>
      3. The Registration Rights Agreement, as amended by this Amendment, is
hereby in all respects confirmed.

      4. This Amendment shall be governed by and construed in accordance with
the laws of the State of Delaware.

      5. This Amendment may be executed in two or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute
one and the same instrument.

                                         UNITED SURGICAL PARTNERS
                                         INTERNATIONAL, INC.

                                         By /s/ DONALD STEEN
                                                Donald Steen
                                                Chief ExecutiveEXHIBIT 4.3.5

                                 AMENDMENT NO. 4

                                       TO

                              AMENDED AND RESTATED
                          REGISTRATION RIGHTS AGREEMENT

      THIS AMENDMENT NO. 4 to the Amended and Restated Registration Rights
Agreement, dated as of December 22, 1998 (the "Amendment"), is entered into by
and among United Surgical Partners International, Inc., a Delaware corporation
(the "Company"), and the parties named at the foot hereof (each of such parties
being hereinafter referred to individually as a "Purchaser" and collectively as
the "Purchasers"), amending the Amended and Restated Registration Rights
Agreement dated as of April 30, 1998, as amended, among the Company and the
several signatories thereto (the "Registration Rights Agreement").

      Pursuant to the terms of that certain Asset Purchase Agreement, dated as
of December 18, 1998 (the "Purchase Agreement"), among the Company, the
Purchasers and others, the Company is issuing to the Purchasers on the date
hereof, and may hereafter issue, certain shares of the Company's Class A Common
Stock, par value $.01 per share (such shares of Class A Common Stock now or
hereafter issued to the Purchasers being hereinafter collectively called the
"Shares").

      It is a condition to the closing of the transactions contemplated by the
Purchase Agreement that the Company and the Purchasers execute this Amendment.

      Pursuant to Section 13(d) of the Registration Rights Agreement, the
Registration Rights Agreement is hereby amended as follows:

      1. Each Purchaser is hereby made a party to the Registration Rights
Agreement with the same rights and obligations as a holder of "Investor Shares"
(with respect to the Shares) as set forth in the Registration Rights Agreement.

      2. The Registration Rights Agreement, as amended by this Amendment, is
hereby in all respects confirmed.

      3. This Amendment shall be governed by and construed in accordance with
the laws of the State of Delaware.

<PAGE>
      4. This Amendment may be executed in two or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute
one and the same instrument.

      IN WITNESS WHEREOF, the undersigned have executed this Amendment as of the
date first above written.

                                    UNITED SURGICAL PARTNERS
                                    INTERNATIONAL, INC.

                                    By /s/ MICHAEL W. CREWS
                                           Michael W. Crews
                                           Vice President

                                    PURCHASERS

                                    /s/ MICHAEL BINGHAM
                                        Michael Bingham*

                                    /s/ RONALD W. DISNEY
                                        Ronald W. Disney*

*On behalf of themselves and each entity that they directly or indirectly own or
control and which may be issued any Shares pursuant to the Purchase Agreement,
including without limitation Disney Oak Mount, L.L.P. and Bingham Forest Edge,
L.L.P. (and each of the partners in such entities).

                                      -2-
<PAGE>
      4. This Amendment may be executed in two or more counterparts, each of
which shall be deemed an original, but all of which together shall constitute
one and the same instrument.

      IN WITNESS WHEREOF, the undersigned have executed this Amendment as of the
date first above written.

                                    UNITED SURGICAL PARTNERS
                                    INTERNATIONAL, INC.

                                    By_______________________________
                                           Michael W. Crews
                                           Vice President

                                    PURCHASERS

                                    /s/ MICHAEL BINGHAM
                                        Michael Bingham*

                                    /s/ RONALD W. DISNEY
                                        Ronald W. Disney*

*On behalf of themselves and each entity that they directly or indirectly own or
control and which may be issued any Shares pursuant to the Purchase Agreement,
including without limitation Disney Oak Mount, L.L.P. and Bingharn Forest Edge,
L.L.P. (and each of the partners in such entities).

                                      -2-

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