What is chordee (bent penis) and why do hypospadias have chordee? How is chordee correction surgery done?

Posted on April 13, 2015 by Dr. A K Singal

Chordee means that the penis is bent (curved penis). Penis mostly gets bent downwards hence it is called ventral chordee and is seen commonly seen in children with hypospadias. In children with other type of anomaly which is much rarer than hypospadias called epispadias the penis may be bent upwards, it is called dorsal chordee. Hypospadias is atleast 20-30 times more common than epispadias, hence when someone uses the word chordee it is by fault supposed to mean ventral chordee as seen in hypospadias.

Why does chordee happen?

When the penis is getting formed between 8-12 weeks of pregnancy, the urethra (urinary passage) also starts getting formed from the base of penis to the tip of penis. This happens gradually under the 3influence of male hormones produced by the testis. All around urethra, a special tissue called corpus spongiosum is also formed through which the urethra runs. The two cylinders of tissue called corpus cavernosa are also formed. Together equal sizes of spongiosum and two cavernosa cylinder are responsible for a straight penis. When the urethra is short as in hypospadias, the spongiosum tissue is a3lso short, the skin and dartos tissue under skin is also short and sometimes the corpora can also be curved. Hence chordee results from this shortage of these tissues on underside of penis.

Do all hypospadias have chordee?

Chordee is seen more than 50% of all hypospadias but this also depends on the severity of hypospadias. Generally, the more severe the hypospadias is, higher the chances of chordee. Hence, chordee is more common in scrotal hypospadias than distal penile hypospadias. This is a generalization and it is not true in all cases as we have seen lot of cases of chordee without hypospadias and also minor hypospadias having a major degree of chordee.

How is chordee checked and graded?

Chordee can sometimes be seen by the parents when the child has an early morning erection which happens even in small babies. Generally we tell the parents to click the picture from the side to document the chordee degree. Chordee must always be checked during hypospadias surgery by doing an artificial erection test. This is infact a mandatory test for all hypospadias and the most important thing to be taken care of during hypospadias surgery. If chordee is not checked and left untreated, it can create lot of issues in adulthood and need surgery again which is much more difficult in adulthood. Chordee is graded in degrees like 30 degrees, 45 degrees or 90 degrees or also as mild, moderate or severe.

Does chordee always need surgery repair?

A straight penis is important to have straight stream of urine as well as for having normal sexual intercourse. Hence, if the penis has anything more than 15-20 degrees of bend should be corrected.

How is chordee repair surgery done?

  • Degloving of penis: In any hypospadias surgery or chordee repair surgery, the first step is called degloving of penis. Degloving means that the penis skin is taken down till the base of penis by a circular incision around head of penis while saving the opening of hypospadias and urethral plate. Generally, there are some abnormal tissues around base of penis which cause chordee and once these are divided chordee gets corrected in most cases. Then a tourniquet is applied on the base of penis and saline solution is injected into the head of penis or corporal bodies. This is called artificial erection test and allows the hypospadias surgeon to assess the degree of chordee.
  • Tunica albuginea plication: If there is still chordee then further steps need to be done to correct chordee. If the chordee is mild, then we perform tighten the top side of penis with a non-absorbable stitch to straighten the penis.
  • Division of urethral plate: If the chordee is still severe then a cut needs to be given to divide the urethral plate between hypospadias opening and the head of penis.
  • Dermal graft for chordee correction: Chordee is again checked and if it still severe then corpora needs to be lengthened by placing a dermal graft on underside of penis. In case a dermal graft is placed, then a single staged repair can’t be done and a staged hypospadias repair is done.

It is important for a hypospadias surgeon to make sure that the chordee is completely corrected during hypospadias surgery. It requires experience to do a stepwise assessment of the chordee in every individual case and then proceed with chordee repair as detailed above. The importance of having a straight penis cannot be overemphasized.

About the author:

Dr A.K.Singal

Dr A.K.Singal during Hypospadias surgery

Dr A.K.Singal is a renowned Pediatric urologist and is one of the best & most experienced hypospadias surgeons across India and world. His deep interest, research, knowledge has helped hundreds of children and adults with hypospadias achieve a satisfactory cosmetic and functional results of hypospadias. Dr Singal is available in Fortis Hospital in Mulund Mumbai, Jupiter hospital in Thane, Fortis Hospital in Vashi (Navi Mumbai) and MITR Hospital & Hypospadias Foundation in Kharghar, Navi Mumbai, India. To reach him you can send him an email at hypospadiasfoundationindia@gmail.com or fill up this form:

Contact form for Dr Singal

Also, you can call up Dr Rajkumar, Dr Singal’s assistant and Coordinator of Hypospadias Foundation on +91-9821261448

Video of Glanular Hypospadias with chordee surgery repair by Dr A.K.Singal

Video of Distal penile hypospadias repair procedure by Dr A.K.Singal

Video of proximal penile hypospadias repair surgery procedure by Dr A.K.Singal

Video of scrotal hypospadias single stage repair procedure by Dr A.K.Singal

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Posted in About Hypospadias,For Parents and Patients | Posted by Dr. A K Singal | Posted on April 13, 2015 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Distal Penile Hypospadias in a child: Single stage repair surgery video using TIP urethroplasty (Snodgrass repair)

Posted on December 4, 2014 by Dr. A K Singal

Distal penile hypospadias is the most common type of hypospadias in children. The urethral opening is located on the underside of penis but in last 1/3 of the penis. While some of the distal hypospadias may have an associated bend in penis called Chordee, most of the distal hypospadias may not have a chordee. There are many types of hypospadias surgery techniques described and the hypospadias surgeon selects the type of repair depending on the anatomy.

The key factors in deciding the repair are:

  1. Severity of Chordee
  2. Severity of hypospadias
  3. Quality of urethral plate
  4. Experience of the surgeon

Snodgrass repair or Tubularised incised plate urethroplasty was described by Dr Warren Snodgrass in 1992 and relies on using the natural tissues of penis on the underside for making a new urinary passage. The basic concept is midline incision of the open urethra from the urinary opening till the head of penis. This expands the urethral plate and allows it rolled into a new urethral tube which can heal very well.

The critical steps are:

  • Degloving of the penis: Incisions are marked preserving the urethral plate and all the penile skin is taken down to correct chordee. This step doesn’t harm the nerve and blood supply of penis as that runs deep inside the penis.
  • Artificial erection test: After applying a tourniquet, artificial erection test is done to check for any curvature (chordee). If there is no curvature, urethroplasty can be started.
  • Chordee correction: In most of the children with distal hypospadias, degloving alone releases the bands on underside of the penis and chordee gets corrected. In some children with hypospadias, chordee correction may be needed. This can be done by either putting a stitch – Tunica albuginea plication or by dividing the urethral plate. Urethral plate division is needed only in patients with severe chordee. But once the urethral plate is divided, TIP urethroplasty can’t be done, other types of repairs have to be planned.
  • Glans wings: Urethral plate is dissected into glans, creating glans wings on either side which are mobilized deep. Midline urethral plate incision (TIP incision) is given to expand the urethral plate and then urethra is closed with a fine absorbable suture such as PDS or vicryl to construct the new tube. The sutures are taken in a subepithelial fashion to invert the mucosa.
  • Second layer coverage: If there is good corpus spongiosum around urethral plate, it is mobilized for spongioplasty to provide security from urethral fistula. We also routinely use Dartos flap to cover the urethroplasty and prevent complications such as urethral fistula.
  • Glansplasty and skin coverage: Glans wings are closed with absorbable sutures and excess foreskin on the top is divided in midline and brought ventrally for complete skin coverage. Midline closure is achieved after excising excess skin so that a pleasing cosmetic outcome can be sought.
  • Dressing and catheter: Though lot surgeons use bulky dressings after hypospadias surgery, we use mostly a Tegaderm (transparent plastic wrap) followed by a soft gauze dressing. The catheter is tied to the glans stitch and allowed to drip urine into the diaper.

Follow-up and care after hypospadias repair surgery with TIP urethroplasty:

Most of the children are discharged by the evening of hypospadias surgery. Antibiotic syrup, pain killers and antispasmodic medicines are given for a week’s time. The parents are taught double diaper care and we call the children for follow-up after 5-7 days for removal of dressing and catheter at the same time. The hypospadias dressing is removed in clinic itself and the parents are advised to apply an antibiotic ointment on the penis for 2-3 weeks. Bath can be given as soon as the dressing is removed. We call for follow-up two weeks after catheter removal and after 3 months if everything is healing well.

About the author:

Dr A.K.Singal is a renowned Pediatric Urologist and Hypospadias Surgeon practicing in western india in area of Mumbai, Navi Mumbai and Thane. He is counted as one of the best hypospadias expert surgeons in the world and every year manages more than 200 kids and adults with hypospadias. He started Hypospadias Foundation in 2008 and Hypospadias Foundation remains the world’s only organisation dedicated to children with Hypospadias. Children from more than 20 countries travel every year to India to consult for hypospadias treatment under his team’s care.

Dr A.K.Singal

Dr A.K.Singal during Hypospadias surgery

He is available at the following clinics : Clinics and Timings for Dr A.K.Singal

Watch video of Distal penile hypospadias repair surgery video by Dr A.K.Singal

Watch video of Single stage repair surgery of severe hypospadias by Dr A.K.Singal

Watch Video of repair of glanular hypospadias with chordee by Dr A.K.Singal

To send an enquiry to Dr Singal’s team please fill up this form:

Contact form for Hypospadias enquiry

 

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Posted in About Hypospadias,For Parents and Patients,Hypospadias surgeon India,Hypospadias Surgeon Thane,Hypospadias Surgery,Hypospadias surgery video | Posted by Dr. A K Singal | Posted on December 4, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Post-operative instructions and home care after hypospadias repair surgery

Posted on August 17, 2014 by Dr. A K Singal

Hypospadias surgery is a delicate, skillful and complicated surgery. The good thing about hypospadias treatment is that young babies heal very fast and become well within a week to ten days after the hypospadias repair. Fortunately, unlike adults, the children do not think about pain. They live their life happily soaking in, everything moment to moment. Adults on the other hand think and anticipate pain too much hence they land up having more pain. It is the anticipation of the pain which is worse than the pain itself.

That being said, here we have tried to give detailed post hypospadias repair instructions for the parents and patients so that they can understand the care which needs to be taken after hypospadias surgery. Please note that these are generalized instructions after hypospadias surgery and there will be some variations on a case to case basis and it is best to discuss with your hypospadias surgeon for other details.

  • Diet: Children can often be fed 2-3 hours after hypospadias repair if the surgery was done under sedation and caudal epidural anesthesia. Some complex or failed hypospadias may require general anesthesia for surgery and these kids are kept empty stomach for 3-4 hours after surgery.
  • Urine passage: In almost all the hypospadias repairs, there is urinary pipe called catheter which is left across the hypospadias repair site. This goes into the bladder and drains drops of urine continuously. It is generally removed after 5-10 days by the hypospadias specialist depending on the type of the repair.
  • Diaper care: Post hypospadias treatment babies are kept in double diapers till the time the catheter is there. If the child is more than 6-7 years of age, then diapers may be difficult to maintain- hence we prefer to use a urine bag for drainage of urine. We ask the parents to make a hole on the front side of inner diaper and bring out the catheter to drain into the outer diaper. This way the inner diaper is changed only when the child passes motions and hence remains dry. Outside diaper is changed whenever it is full of urine.
  • Hypospadias Dressing care: At the end of hypospadias surgery, we place a soft gauze roll dressing on penis to give some support to the healing penis. There may be minor bleeding into the diaper on and off for first 3-4 days which is nothing to worry about. The hypospadias dressing sometimes becomes loose and comes out. If this happens within first 2-3 days, then we change the hypospadias dressing. If it happens later, we just remove the dressing and leave the wound open.
  • Discharge after hypospadias surgery: Most of the children who have a simple primary hypospadias are discharged the same day of surgery by evening- daycare hypospadias surgery. Children who are traveling from far may come the night before to hospital and stay for a day or two after surgery as well. Children who have undergone a failed hypospadias or a complex surgery are kept in hospital for 2 nights after surgery also for antibiotic injections or pain relief etc.
  • Pain relief: We prescribe an oral syrup of analgesic medicine mostly a combination of ibuprofen and paracetamol for first few days after surgery. This ideally should be given post feeds and not on empty stomach. We also give a medicine called oxybutynin which is an anticholinergic and prevents bladder spasms (painful bladder contractions due to catheter).
  • Medications: A broad spectrum antibiotic such as cephalexin is also prescribed to prevent infections along with an antacid medicine such as Lansoprozole for the first few days.
  • Activity, walking, playing within the house is allowed even the day of surgery by evening but we ask the parents to make sure that the child does not use cycle or any toy on which straddling is needed. Child can sleep on his tummy if he likes to sleep that way. Double diapers prevent too much compression of the hypospadias repair site.
  • Visits with doctor: We like to see the patients on day 5 after surgery for removal of dressing and for some minor hypospadias repairs we remove the catheter also at the same time. If its moderate or severe hypospadias surgery, we generally remove the catheter after 7-10 days and hence the catheter is removed on second visit then.
  • Bathing: Once the dressing is out on day 5, the child can be given a short warm tub bath. We ask parents not to use any cotton or cloth for drying the area of hypospadias repair surgery as fibers can stick to the raw area. It is better than after drying the rest of the body the diaper is put on directly and that will dry the area.
  • Ointments on penis: We advise putting a broad spectrum antibiotic ointment such as neosporin locally on the penis at each diaper change so that it prevents infection and also protects the raw area from sticking to the diaper.

We hope this little primer on care of children after hypospadias surgery helped you. Please feel free to get in touch with us if you need any further information. We hope and pray that your little kid becomes better soon and recovers well from hypospadias surgery.

 

About the author:

Dr Arbinder Singal, Pediatric urologist

Dr A.K.Singal delivering his talk at ESPU

Dr A.K.Singal is one of the best hypospadias surgeons and Pediatric Urologists in India. He practices in Navi Mumbai, Thane and Mumbai area of India. Dr Singal believes in giving as much information to parents and families as possible about surgery, pre surgery and post surgery course. It helps the parents to be fully informed as he says in his own humorous way- “it decreases my stress and time per consult”

In case you have a child with hypospadias, you can contact him at the following places:

1.      MITR Hospital & Hypospadias Foundation

74-90, 1st Floor, Above IDBI Bank, Chaturbhuj, Shilp Chowk

Sector-21, Kharghar, Navi Mumbai- 410210

Mon & Fri: 5:00-6:30pm, Tues: 12-1pm, Appointments: +91-22-27743558/4229 & 09324180553

 2.      Fortis Hospital, Mulund

Mulund Goregaon Link Road, Mulund, Mumbai – 400078

Wed & Sat: 4:00pm-5:00pm, Appointments: +91- 22- 43654365; 67994185

3.      Jupiter Hospital, Thane

Wed & Saturday, 2:00pm-3:00pm, Appointments: +91-22-21725563/ 55 

4.      MGM’s New Bombay Hospital, Vashi.

Sector-3, Vashi-400703, Navi Mumbai

Mon, Wed & Fri: 7:00-8:00pm, Phone: +91-22-61526666/ 6675/ 6607

5.      MITR Clinic, Vashi

C1/8, Sector- 2, Opp. Green City, Vashi, Navi Mumbai

Tue & Sat: 7:00pm-8:00pm, Appointments: +91-22-65163816 & 9324502572

6.      Fortis Hiranandani Hospital, Vashi

Miniseashore road, Sector-10, Vashi, Navi Mumbai

Tue & Sat: 6:00pm-7:00pm, Appointments: +91-22-39199200, 222

 

Email address: arbinders@gmail.com

Websites:

www.pediatricurology.in, www.hypospadiasfoundation.com, www.mitrhospital.com

Youtube channel: www.youtube.com/pedurohypospadias

Videos:

Single stage repair of severe hypospadias

Interview: Dr Singal speaks about Hypospadias

 

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Posted in About Hypospadias,For Parents and Patients | Posted by Dr. A K Singal | Posted on August 17, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Checklist before Hypospadias Repair Surgery

Posted on June 10, 2014 by Dr. A K Singal

Hypospadias is a birth defect which affects a vital organ of the body- Penis. Penis is the most important organ for urinary and sexual function in a male. Though everyone worries more about sexual function, let me tell you as an expert hypospadias surgeon and a pediatric urologist that both urinary and sexual functions are equally important. While we may need penis for sexual function may be once or twice a day and for maybe for 30-40 years in our lives, we certainly need it for urinary function right from birth till we die and many more times each day. Hence the purpose of hypospadias repair is to set both the functions right in one go- single stage urethroplasty. This includes correction of the curvature of the penis (chordee correction) as well as making a good caliber smooth new urethra till the tip of penis.

But all said and done – Hypospadias treatment means a surgery. Surgery word itself is very scary and it requires a lot of courage and faith for the parents to handover their little one to a surgeon and let me tell you it is not easy for parents to hand over their young kid for a surgery. Lot of things go around in their minds about risks, results and safety of both surgery and anesthesia. Having been a pediatric urologist for almost a decade now, I can feel their helplessness and pain. I never let these feelings overpower me and become a stumbling block to delivering good care. I try to channelize them in the right way and empathize with the family and tell them upfront that I know how they are feeling. And then I tell them what all safety precautions and risk mitigation strategies we have lined up for the hypospadias surgery. My favorite sentence at this juncture is “Safety first everything else later”.

An helmet/ bike analogy works well in this situation: we should always follow all precautions before we go for a bike ride and most importantly wearing a helmet. We may wear a helmet a thousand times and not have an accident but the day we don’t wear it that is the day when we are vulnerable and if something happens- it will be life threatening. Similarly, while doing a hypospadias surgery on a small kid we also take all precautions to make sure that we are absolutely prepared even if something happens in that rare 1/1000 chances.

Hypospadias Surgery Checklist:

  1. Pre-operative fitness tests: A thorough history is taken for any evidence of infection, other illness and any familial disorders. A complete blood count and a urine test is done to check for body parameters. A pediatrician consult is often taken for a systemic examination. Chest xray is no longer recommended routinely before elective surgery if the chest examination is normal.
  2. Pediatric Anesthesiologist: An anesthesia doctor adept at handling kids and regularly giving anesthesia to small kids is the second most important team member after the pediatric urologist.
  3. Hypospadias surgery set: Hypospadias repair surgery require fine, sharp and specialized microsurgery instruments- we keep is separately as a “Hypospadias Set” which is not used for any other surgery.
  4. Operation theatre: OT needs to be clean, sterilized, have all safety equipment for anesthesia, good lighting and all possible infection control measures.
  5. Antibiotic dose just before surgery: We give a dose of injectable broad spectrum antibiotic just before starting the surgery as an infection prevention measure.
  6. Trained staff: Well-trained nursing and junior doctor staff is needed both while assisting surgeries as well as post-operative management, since at Hypospadias foundation at MITR Hospital, Navi Mumbai, India- we do more than 150 hypospadias repairs every year- even the ward assistants know the care of these babies after surgery.
  7. Standardised protocol of surgery:  This has been covered in another blog- read it here.

As a Pediatric Urologist and Hypospadias Specialist, I feel overwhelmed when parents trust me and handover their little ones under my care. It is a big responsibility and I try my best to handle them with care. Trust and faith that everything will be fine goes a long way in finding a cure for hypospadias. After all we are all instruments of god trying to do our best. As long as the intentions and efforts are honest, the results will also be good.

About Dr A.K.Singal: Dr Singal is a renowned and top pediatric urologist & one of the best hypospadias surgeons in India. He is well known for single stage hypospadias surgical corrections. He operates children with hypospadias at his centre @ Hypospadias Foundation at Kharghar Navi Mumbai, at MGM & Fortis Hospitals in Vashi, at Fortis Hospital in Mulund, Mumbai and at Jupiter Hospital in Thane.

Dr A.K.Singal

Dr A.K.Singal during Hypospadias surgery

Please feel free to write to us for an opinion at hypospadiasfoundationindia@gmail.com or fill this contact form http://hypospadiasfoundation.com/contact-patient.htm

Watch videos on our Youtube Channel:

https://www.youtube.com/watch?v=HGRDZGXlffY

https://www.youtube.com/watch?v=M9_buN10lUE

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Posted in About Hypospadias,For Parents and Patients | Posted by Dr. A K Singal | Posted on June 10, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Complications after Hypospadias Repair Surgery in children

Posted on May 4, 2014 by Dr. A K Singal

Hypospadias repair surgery is a very delicate and demanding surgery. It tests the ingenuity of the hypospadias surgeon, surgery skills and most importantly experience. We have realized that hypospadias repair procedure is not a surgery which can be done casually or as one of the many surgeries which a surgeon does. Best results of hypospadias surgeries are seen only when the surgeon dedicates his time and energy in pursuing the art and science of hypospadiology. Results keep on improving day by day and year by year. With more than 600 hypospadias repairs done over last 5 years, Hypospadias Foundation at MITR Hospital, Navi Mumbai, India provides the best results in hypospadias surgeries in south East asia. Children have travelled from all over India and other countries such as Nigeria, Greece, Bangladesh, Iraq, UAE to get treated under Dr Singal’s care for hypospadias.

To get the best outcome in hypospadias, it requires a big team effort which includes hypospadias surgeon, assistants, well trained OT staff and post-surgery caring staff.

No surgery is free of complication and complications happen even in the best of hypospadias surgeon’s hands though they keep in decreasing with advancing experience. Whenever we see any child with hypospadias in our clinic, we make sure that we discuss in detail about the possibility of complications and the post hypospadias surgery outcomes. Some of these we discuss it further here:

Immediate complications after hypospadias repair:

  1. Bleeding – Penis is a very vascular organ with a lot of blood supply. Since hypospadias surgery involves lot of dissection of penis and making of various flaps, suturing them back in proper way is very vital in preventing this complication. The bleeding is usually minor and stops in 2-3 days. Earlier we used to apply heavy and tight dressings after hypospadias surgery but now we have realized that these actually delay healing as they compress the healing tissue. So presently the dressings which we use are very soft and light.
  2. Infection- After any surgery, the immunity of the body goes down plus there is raw area which invites growth of infection causing bacteria.  Fortunately, when we do hypospadias repair in children, infection is very rare and even if it occurs is usually superficial and resolves with antibiotics. Various preventive actions are taken before hypospadias repair such as very sterile techniques in operation theatre, broad spectrum antibiotic at start of surgery and 8 hours after surgery, oral antibiotics after surgery and careful handling post-surgery.

Short term complications after hypospadias repair:

  1. Urethral Fistula: Fistula implies leakage of urine somewhere from the newly formed urethral tube below the tip of penis. This occurs because of improper healing resulting from poor blood supply, infection, tight stitches or just poor surgical technique. Sometimes the urethral fistula after hypospadias surgery may heal by itself but mostly it requires surgery which is recommended only after 6 months of first hypospadias surgery. Fistula occurrence depends on experience of the hypospadias surgeon, severity of hypospadias and technique.
  2. Meatal stenosis: This refers to a tight urinary opening after surgery of hypospadias. This can be seen even 2 weeks after surgery and may need regular calibration or minor cut back procedure called meatotomy in some cases.
  3. Diverticulum: This refers to formation of a baggy distended urethral tube and is visible during passage of urine. This may be seen after an onlay flap repair for hypospadias as the skin flap expands and balloons during passage of urine. With careful trimming of the flap during surgery, this has become much less common and occurs in less than 1% of cases after hypospadias surgery.
  4. Stricture: Sometimes during the healing phase, the new urethral tube may become narrow and cause obstruction to urine flow. This is noticed by poor stream, straining (application of force) during passage of urine and long time taken to pass urine. This may require further treatment in form of dilatation or a second surgery some months later.
  5. Dehiscence/ breakdown: Very rarely, the whole repair may breakdown due to poor healing, infection or loss of blood supply requiring more surgeries. This is very uncommon and unfortunate event necessitating a complete redo repair of the hypospadias.

With the newer techniques of hypospadias repair and growing experience of hypospadias surgeons, the complications have become much less common after hypospadias surgery and even when they occur they can be managed well. It is well said that “the prepared mind never knows much trouble”. Once we know that complications can occur in any surgery and be prepared for them, it is much easier to initiate preventive action during surgery itself. Also, it is vital to identify complications earlier so that they can be managed well in time before any long term damage occurs.

About the author:

Dr A.K.Singal is a Pediatric urologist and is renowned as one of the best hypospadias surgeons in India for his dedication towards Hypospadias and excellent results of hypospadias surgery. He has been an invited speaker in various national and international medical conferences and workshops for hypospadias. He is also the founder of Hypospadias Foundation – an organization dedicated to best of care for children with hypospadias. Dr Singal practices art and science of hypospadias treatment in Mumbai and Navi Mumbai area of western India.

Visit Hypospadias Channel https://www.youtube.com/user/pedurohypospadias

Watch videos of Hypospadias surgery by Dr A.K.Singal

https://www.youtube.com/watch?v=HGRDZGXlffY

https://www.youtube.com/watch?v=M9_buN10lUE

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Posted in About Hypospadias,For Parents and Patients | Posted by Dr. A K Singal | Posted on May 4, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Cost of Hypospadias Surgery in India

Posted on February 14, 2014 by Dr. A K Singal

Hypospadias is a very common birth defect affecting up to 1/150 newborn baby boys. In the current era most of the couples choose to have one or maximum two children and that too with a lot of planning. The moment the newborn baby boy is diagnosed to have hypospadias – besides distress and worry for the baby’s health and future parents also start worrying about other things. These are:

While the first three questions have been answered elsewhere, the last question forms the substance of this blog. Parents always worry ” Is hypospadias repair surgery going to be very expensive?, Would my insurance policy pay for hypospadias surgery since hypospadias is a birth defect”

The cost of hypospadias repair surgery varies according to the type & severity of the hypospadias, type of surgical technique, time taken by the hypospadias surgeon, assistant used or not and finally type of room taken- general ward or shared room or a single deluxe room.

  • Elaborating further – for a mild variety of hypospadias like glanular/ distal penile hypospadias with mild chordee, an expert hypospadias surgeon will take under one hour for surgery, work without assistant surgeon and the charges may start from 1000 US Dollars (60,000 Indian rupees) while for a severe hypospadias such as scrotal/ perineal hypospadias the charges may go upto 3500 US dollars (2,00,000 Indian rupees) for a single stage urethroplasty.
  • Some of the hospitals in Mumbai may be more expensive than say for example Hypospadias Foundation at MITR Hospital in Navi Mumbai.
  • For some of the severe hypospadias a staged urethroplasty repair may be needed and then the budget may extend further but this happens in less than 5% of the cases. Though at Hypospadias Foundation located at MITR Hospital in Kharghar, Navi Mumbai, majority of our hypospadias repair surgeries are single stage urethroplasty surgeries, still in 4-5% of the children referred to us, the hypospadias may have a very severe chordee necessitating a two stage approach for better long term outcomes.

Hence, the actual charges of hypospadias repair can only be decided after a full hypospadias examination and discussion with the parents face to face.

Similar hypospadias surgery in USA carries upto ten times the charges and maybe 5-6 times of Indian charges in Europe. When looked at in context of India, though most of the families are able to afford these expenses, for some indian families these may still be high. Some of these families get support from Hypospadias Foundation either as medical consumables support or by way of some discounts in surgeries at Hypospadias Foundation. We have tried to ensure a policy of NEVER Saying NO to a child with hypospadias for economic reasons. If the intent is right, money comes in as Donations etc.

Coverage of Hypospadias by Insurance Companies:

Hypospadias being a birth defect is generally not covered by most of the insurance companies in India atleast while in USA, UK it is covered under insurance benefits. Some of the corporate insurance group covers do include all pre-existing as well as birth defects for their employees and hence hypospadias repair procedure may be covered by the insurance company by some of these companies.

In the other cases, the parents usually end up paying up these charges by themselves out of their own pocket. For new parents working in a job or middle class environment this may be stressful. What helps is that Hypospadias repair surgery is a planned procedure. It can be done anytime between 6 months-15 months of age giving parents enough time to rally around and arrange everything from money to other resources. Hence, it is best that they meet a hypospadias expert or a pediatric urologist early on in first 1-2 months and then learn everything about the charges, hospital stay, pre-hypospadias surgery tests and then get mentally prepared for the actual surgery.

Please feel write to us for an opinion at hypospadiasfoundationindia@gmail.com or fill this contact form Contact Hypospadias Foundation

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Posted in About Hypospadias,For Parents and Patients | Posted by Dr. A K Singal | Posted on February 14, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Goals of Hypospadias Repair Surgery

Posted on February 8, 2014 by Dr. A K Singal

Before we talk about goals of hypospadias surgery, let’s understand the issues in uncorrected hypospadias.

Anatomical defects in Hypospadias: Hypospadias encompasses two basic structural defects in the penis- abnormal location of the urinary opening and chordee (bend in the penis). Another minor defect is incomplete foreskin (prepuce) which does not lead to much cosmetic or functional impairment. We regularly use prepuce and its internal tissues for performing a strong structural hypospadias repair, hence circumcision most often is a part of the procedure.

Functional issues in Hypospadias: Functionally, penis has two important aspects:

  1. Ensure Smooth uninterrupted flow of urine-possible by a wide caliber of urethra
  2. Sexual organ for intercourse and also for passage of semen for fertility

Except in minor hypospadias, in all moderate to severe hypospadias both these functions are impaired unless corrected.

Cosmetic deformity in Hypospadias: Last but not the least, except for very minor hypospadias without chordee – all the other hypospadias lead to significant cosmetic deformity which most of the teenagers and adults would not accept as normal. Genital perception is important in overall normal development of the child into a balanced teenager and adult later on.

Goals of Hypospadias repair: Hypospadias surgery procedure (urethroplasty) mostly in single stage and rarely in multiple stages (depending on the severity of hypospadias) aims to correct these structural defects, impart a good functional outcome both from urinary perspective all throughout life and later in adulthood for sexual purposes with a good cosmetic appearance.

Hence, when doing the hypospadias correction, a hypospadias expert surgeon keeps all these goals in mind. The stepwise approach with a standardized protocol helps in achieving all these goals. Over the last two decades, lot of research and dedicated best hypospadias surgeons have made sure that the anatomy and functional aspects are taken care of in an appropriate manner with long lasting good outcomes.

Stepwise standardized hypospadias surgery protocol

(As practiced by Dr A.K.Singal, Pediatric Urologist & Hypospadias Expert)

After nearly 7 years of dedicated hypospadias surgeries, we and other top hypospadias surgeons have realized that it is very important to follow a standardized approach as follows:

  • Examination under Anesthesia with magnification: The clinical examination done in outpatient department may not have been sufficient. Re-examining the child under anesthesia in detail while wearing magnifying loupes allows a hypospadias surgeon to create a mental roadmap. While scrubbing, draping, painting this roadmap provides a reliable navigation and focus to achieve best results during hypospadias repair.
  • Marking of skin incisions and injection of anesthetic agent with adrenaline: We routinely as a first step mark the incision sites and then inject dilute xylocaine and adrenaline and then wait for five minutes. This prevents minor bleeds from the hypospadias surgery site and keeps the area clean. This also allows decreases the use of electrocautery to stop the bleeding to a minimum.
  • Degloving the penis: Incisions are deepened preserving the nerve and blood supply to penis and whole skin of the penis is taken down – a step called degloving. This is done in all l hypospadias surgeries and most of the times is enough for correction of the chordee. The penis is carefullu delgoved preserving the urethral plate. Till this time, the technique of hypospadias repair is still not decided.
  • Chordee correction: Once penis is completely degloved, an artificial erection test is done to make sure that the penis is straight else various types of chordee correction procedures can be done. Straightening of the penis is the prerequisite for any type of urethroplasty and a surgeon should not move ahead with urethroplasty till chordee correction is satisfactory.
  • Deciding the technique of Hypospadias repair (Urethroplasty): After chordee correction, anatomy is assessed again. If the hypospadias is not very severe and the urethral plate (tissue between urinary opening till the glans) is wide, soft and elastic- a Tubularised Incised plate urethroplasty (Snodgrass repair) can be done). In a proximal hypospadias or a poor urethral plate, onlay island flap repair should be done. If the skin just below the urethral plate is good, then a Mathieu’s flip flap repair can also be done. If the urethral plate has been transected to correct the penis curvature then a precpucial tube repair should be considered or a staged hypospadias repair can be done.
  • Second layer coverage to prevent fistula: A second layer cover over the new urethra is very important to prevent urethral fistula post hypospadias surgery. This can be taken from surrounding spongiosum, dartos fascia from prepuce or tunica vaginalis (covering of the testis)
  • Glansplasty and meatoplasty: Reconstruction of the head of penis is a critical component for good cosmetic result as well as to make sure the opening is wide enough to allow free passage of urine. This is ensured by wide dissection of glans and also while closing the glans new urethra should be able to accommodate a good sized catheter without tension. Meatus should be left wide and an effort is made to make it like a slit like meatus which is cosmetically pleasing.
  • Penile skin closure: Excess prepuce on the top of penis is split in midline and brought on either side towards underside of penis. Jacket shaped incisions are made to remove extra foreskin and then a midline suture line is created for an excellent cosmetic outcome after hypospadias repair.
  • Proper fixation of the catheter: Urethral catheter is fixed with a stitch taken through glans so that it stays inside. The catheter is kept for 5-10 days depending on the type of surgery and healing.
  • Dressing: Decade ago very bulky and tight hypospadias dressings were in vogue, nowadays we use very soft and light dressings which can be removed easily an then let the catheter drain into a double diaper.

Following these sequential hypospadias surgery steps and a standardised protocol over last few years in more than 500 kids, has led to faster surgery, shorter anesthesia times, lesser bleeding, better cosmesis and extremely low rates of complications after hypospadias surgery at Hypospadias Foundation. And most importantly, this has also made sure that all the goals of hypospadias surgery are properly met.

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Posted in About Hypospadias,Hypospadias Surgery | Posted by Dr. A K Singal | Posted on February 8, 2014 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Hypospadias Surgery In India

Posted on October 3, 2013 by Dr. A K Singal

Every year more than 100,000 (1 lakh) boys are born with hypospadias in India.  It is s staggering number.

This incidence has been calculated from birth rate for male babies according to Census 2011 and considering that the worldwide accepted incidence of hypospadias is around 1/150 male births. Further we have adjusted this for infant mortality rate. Though our own research in a population study done by Hypospadias Foundation in Vashi & Nerul areas of Navi Mumbai has shown an incidence of hypospadias around 1/126 male births, the base population was only  1200 births which was not very big, hence we did not use this figure.

At Hypospadias Foundation, we are concerned about this increasing incidence of hypospadias across the globe and we are planning to devote time and resources towards research. At the same time, even if we ignore minor hypospadias and those babies without chordee, in whom we can avoid surgery, still about 70,000-80,000 babies will need hypospadias repair surgeries in India every year.

In India, hypospadias repair surgeries are performed by pediatric urologists (wherever available), pediatric surgeons, urologists as well as some plastic surgeons. Some of these surgeons have learnt the art of hypospadias surgery with a formal pediatric urology training while others have gained experience due to their personal interest and have achieved good results. Fortunately, there are short team visiting courses available at some international centres  and also with the availability of good learning resources on internet, surgeon with special interests in hypospadias can explore multiple avenues for training. Infact the current generation of hypospadias surgeons is learning quickly and also starting their careers at a better knowledge base than surgeons who were learning hypospadias two decades back. Newer instruments, newer surgery techniques and sutures have improved the hypospadias repair outcomes.

At centres like Hypospadias Foundation at MITR Hospital, Navi Mumbai, India – a team  of two surgeons with special interest in Hypospadias – Pediatric Urologist & Hypospadiologist- Dr A.K.Singal and adult urologist – Dr Manish Dubey- work together to enhance the outcomes of surgery both in in children as well as adults with hypospadias. While the aim of the team is to spread awareness and also provide for early surgery in infancy for children with hypospadias, they are also reaching out gradually to many older children and adults with failed hypospadias repairs, persisting or residual hypospadias issues. At Hypospadias Foundation, almost every week, the team gets to see an adolescent or an adult with persistent hypospadias issues such as chordee, urethral fistula, urethral stricture, or poor cosmetic outcome such as buried penis. Some of these patients have multiple problems either due to partly or improperly repaired hypospadias in childhood. These cases are looked after by the team with special attention and effort. You can see such a cases:

14 years old Multiple failed hypospadias surgeries in childhood

With growing team and experience, the number of children and adults undergoing hypospadias surgery at Hypospadias foundation have steadily increased over the last five years. This year in 2013, we will finish with around 150 hypospadias surgeries and though it is good but it not even 1% of the total burden in India. We hope to start training pediatric surgeons and urologists so that within India there is facility for budding surgeons to learn the state of art hypospadias surgery.

Healthcare and specifically surgery is all about trust and for complicated diseases like hypospadias it takes time to achieve trust. Every single child who has undergone a successful surgery at Hypospadias Foundation, the family has spread the goodwill and good word about the dedication of our team.  In the last two years, we have been lucky to be a part of treatment process and lives of lot of outstation and international patients – some have come in from Surat, Jalgaon, Nasik, Kolhapur while others have travelled even from Delhi, Ahmedabad, Bangalore, Jaipur and even as far as Jammu or Calcutta. Internationally, we now offer assistance to 1-2 patients every month from countries like Sri lanka, Bangladesh, Pakistan, Nigeria, Kenya, UAE and Congo. Most of the patients who travel these large distances are either failed hypospadias or complex hypospadias who haven’t been able to get satisfactory counseling or answer to their problems.

Our team at Hypospadias Foundation helps the families with email guidance, online consults, follow-ups and planning travel and surgeries according to availability of Dr Singal and Dr Dubey.

You can watch Videos of Hypospadias Surgery on our youtube channel:

Hypospadias Channel

Videos:

Distal penile hypospadias repair

Severe Hypospadias single stage repair by Dr Singal

Contact Hypospadias Foundation

Dr A.K.Singal can be contacted at

  1. MITR Hospital & Hypospadias Foundation, Kharghar – 022-27742558/ 4229  & 9324180553

Mon/ Wed/ Fri 5:00-6:00pm

  1. MGM Hospital Vashi – 02261526666, 6607

Mon/ Wed/ Fri 7:00-8:00pm

  1. MITR Clinic, Vashi- 02265163816, 9324502572

Tue/ Saturday 7:00-8:00pm

  1. Fortis Hospital, Sector-9, Vashi- 02239199222, 200

Tue/ Saturday 6:00-7:00pm

Watch our youtube channel for videos of Hypospadias surgery – Pediatric Urology & Hypospadias Channel

You can write to us at dr Singal’s email Id – arbinders@gmail.com  for a second opinion or guidance.

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Posted in About Hypospadias | Posted by Dr. A K Singal | Posted on October 3, 2013 by Dr. A K Singal | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Increasing incidence of Hypospadias

Posted on May 12, 2013 by admin

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Hypospadias is recognized as a pediatric urological disorder, the incidence of which is on the rise over the last two decades. While researchers and clinicians agree that the detection and diagnosis rate of hypospadias has increased due to increased awareness, it is also certain that there are other factors which are contributing to the increased incidence of hypospadias.
The last few studies have noted the incidence of hypospadias to be almost 1/150 newborn boys. This is substantial as compared to what was reported to be 1/250 boys two decades back.
To understand what leads to higher incidence of hypospadias we have to understand in a simple language how Hypospadias happens. During the critical phase of sex development in the baby during pregnancy – at around 8 weeks both the male and female sexual organs look similar. Between 8-14 weeks, under the influence of male hormones produced by the testis (Testosterone and Dihydrotestosterone, also called androgens) these organs develop into male organs. These hormones cause the genital tubercle to enlarge and become a penis and at the same time the urinary passage (called urethra) starts developing on the underside of the penis and closes like a zipper from the bottom to the tip of penis. All this is a very intricate coordinated activity and guided by levels and actions of male hormones. Blockage of action of these hormones or lower levels in this critical phase lead to an incomplete urethra resulting in hypospadias. Thus, the urethra falls short of the tip and urethral opening remains on the underside of penis.
Recent research has shown that the rising levels of chemicals in environment so called Endocrine disruptors have been responsible in some ways for this rise in the incidence of hypospadias and other reproductive anomalies such as undescended testis, low sperm counts and testicular cancer. These chemicals come from pesticides, colouring agents, dyes, hair sprays, plastics used in cars, bottles etc. They are all around us and it may take us many years to see their full blown effect on human bodies. Even hormonal treatment for infertility such as IVF, smoking and excessive analgesic use during pregnancy has been shown to have increase the risk of hypospadias. In an environment loaded with pollution and unknown synthetic chemical residues, we can never ascertain fully how the cumulative effect of all these agents affects the gentle developing organs of the baby.
We recently conducted the largest study yet in India about finding out the incidence of hypospadias and undescended testis in India. We found that incidence of undescended testis has increased to almost 5% and hypospadias 1/126 babies in India. Earlier reported incidence for undescended testis was 1.6% in 1971, so it has almost tripled in last 40 years. Hypospadias incidence has not been reported in India yet.
Extrapolating these figures, there will be around 110,000 babies born with Hypospadias every year in India and they will need counseling and proper treatment. Similarly, almost 7 lakh (700,000) babies will be born with undescended testis and almost 30% of these – almost 2 lakh babies (200,000) will need surgery for undescended testis every year. These numbers are not small by any stretch of imagination and call for further research and awareness among general public, governmental organisations as well as doctors.
Dr A.K.Singal, Pediatric urologist & Hypospadiologist, presented these findings at European Society of Pediatric Urology Annual Congress in Genoa, Italy in April 2013. The study was very well appreciated and we won a prize also for it.
At Hypospadias Foundation, we have committed ourselves to excellent clinical care of children with Hypospadias but equally importantly towards meaningful clinical research in the field of Hypospadiology also. In India typically we follow data from the west as we do not have means to collect our own data or just that our priorities towards care for the large population are so huge that we do not have time/ resources for research. Since Hypospadias Foundation is an autonomous body, we have made research our important goal and made it a missionary zeal to collect our own data within India, learn from our own data and then share the research results with the rest of the world.
Medical Science moves forwards by doing clinical work and also analyzing that we are doing today is better than what we did yesterday. But if we can use scientific research tools to find out why hypospadias happen, why are they increasing and what can be done to decrease the incidence – that will be the most fruitful use of science. Prevention is always better than treatment.

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Posted in About Hypospadias | Posted by admin | Posted on May 12, 2013 by admin | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias

Evolution in Hypospadias treatment

Posted on June 8, 2012 by admin

Hypospadias management has undergone big changes in last two decades. The results and outcomes of surgery have improved tremendously making hypospadias management a lesser headache for the doctor and the parents. Two decades back the results for hypospadias surgery were not so predictable and the surgeons and the family all used to be ready for mentally and financially for 2-3 surgeries and that too with suboptimal cosmetic and functional results.

Some of the things which have helped this change are:

  • The newer techniques of  single stage urethroplasty (hypospadias surgery) such as onlay flaps,  Snodgrass repair and prepucial tube repairs.
  • Newer and finer sutures to do the surgery such as PDS, monocryl and vicryl rapide
  • Fine microsurgery instruments for doing surgery on delicate penile tissues
  • Uniform use of optical magnification by surgeons while doing surgery
  • Day care surgery avoiding long hospitalization and infact the whole focus is on sending the children home the same day in most cases
  • Good antibiotics and  pain relief in post surgery period
  • Early age at surgery – Surgery is nowadays usually done at 6-9 months of age for a child who is otherwise well
  • Trained surgeons and teams dedicating time and energy towards giving a good outcome in children with Hypospadias
  • Surgeons with mindset firmly towards doing a single stage repair. Mindset change has been a key catalyst towards single stage surgeries.

For a penile hypospadias whether it is mild, moderate or severe (distal, mid or proximal penile), the success rates for a single stage urethroplasty are close to 95% now; meaning that only 5% of the children require a second surgery for urethral fistula and even lesser for a stenosis. This is very heartening and gives confidence to the family as well as the doctor treating children with hypospadias. For such cases, it has become like any other surgery now, the child comes to the hospital on the morning of surgery, gets the surgery done in 1-2 hours, goes home by evening playful, active and pain free. Only thing the parents need to take care is regular medicines and diaper changes. This is certainly a huge step from 1990’s where these kids were kept admitted in the hospital for a week or ten days while they recovered after surgery.

At home children eat better, feel better, are with family and there are lesser chances of hospital acquired infections with resistant bacteria. Happiness and good food is a key ingredient for a child getting a favorable result and this component is often understated and misunderstood. Keeping the child for a prolonged duration of time in hospital only increases cost of the surgery, amount of medicines used, discomfort faced by family and also risk of hospital acquired infections.

Surgeon training in Pediatric Urology also has a great bearing on the outcomes of hypospadias repairs. With advancing experience, depth of academic and anatomical knowledge, devotion of time to hypospadias is the key to better results seen for some surgeons. It is often said that in Pediatric Urology specialty, to have good results in hypospadias surgery is often the acid test. It may be easier to excel in Laparoscopy or Endourology but still challenging to provide uniformly good results in hypospadias. The repairs and the depth of knowledge and understanding required is challenging and first few cases are unpredictable with respect to outcomes and a lot of young surgeons get disheartened and stop investing themselves into the art and science of hypospadias management. First few failures often bring out the fears and some surgeons find it difficult to continue in this unsure scenario. I still don’t know a single surgeon who never had a complication with hypospadias repairs or has stopped having complications in hypospadias. They do happen even with the most dedicated & expereinced surgeons as medical science is often an imperfect science thus lending the term “I practice medicine” but with growing volumes or experience and most importantly using the catalyst of dedication the results can quickly become very good, predictable and measurable. The complication rates/ second surgery rates become manageable and suddenly it seems enjoyable.

It is very important that a surgeon enjoys his work- it should be like meditation while doing surgery wearing magnifying loupes with all the attention solely on a 2 inch area trying to finish the nature’s unfinished business with human hands. When this happens, that is when the results are acceptable to the surgeon and the parents.

Distal Penile Hypospadias repair surgery by Dr Singal

Severe Scrotal Hypospadias- Single stage repair by Dr A.K.Singal

 

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Posted in About Hypospadias | Posted by admin | Posted on June 8, 2012 by admin | Tagged after hypospadias surgery, best hypospadias hospital, flap repair for hypospadias, hypospadias clinic in india, hypospadias surgeon bhopal, hypospadias surgeon in MP, hypospadias surgeon India, hypospadias surgery india, one stage surgery for hypospadias, onlay flap urethroplasty, onlay island flap hypospadias repair, results of hypospadias, results of scrotal hypospadias surgery, scrotal hypospadias, scrotal hypospadias repair, scrotal hypospadias surgery, severe hypospadias, single stage urethroplasty, urethroplasty for scrotal hypospadias