A boy with distal penile hypospadias - Snodgrass urethroplasty (also called Tubularised Incised Plate urethroplasty)

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis (Coronal Hypospdias) and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hyoplastic urethra. These types of hypospadias may deceptively look mild as the thin distal urethra often needs to be excised and the hypospadias becomes a severe one. The child was planned for a single stage hypospadias repair by Dr A.K.Singal (Hypospadias Specialist)

During hypospadias surgery, hypoplastic urethra was excised and the penis was straightened (chordee reapir). A flap was made from the excess skin on the upper side of penis – this technique of Single Stage Urethroplasty is called Transverse Island Flap Urethroplasty. The flap was rotated towards the underside of penis for making a new urinary pipe. The baby was discharged the next day after surgical correction of hypospadias and double diaper was used for draining the catheter.

Dressing was removed five days after single stage urethroplasty and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis indicating a successful hypospadias surgery

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Facts about Hypospadias

  • Hypospadias is one of the most common anomalies worldwide.
  • The correct age for corrective surgery is between 6-9 months.
  • Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
  • The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
  • Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery.
  • Link to Hypospadias foundation
  • Link to FAQ's about hypospadias

 



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