Hypospadias is classified according to the site of the urinary opening from distal penile being the mildest to scrotal hypospadias being the severest. Fortunately 70% of the hypospadias are distal penile in variety and 20% are moderate variety which includes midpenile or proximal penile hypospadias. Only 10% of the hypospadias are of severe variety- penoscrotal or scrotal hypospadias. Hence, out of the children whom we see in our Hypospadias clinic, ideally less than 10% should be severe hypospadias. But since we are a specialized and one of its kind hypospadias hospital in India, almost 20-30% of our cases are severe hypospadias. For distal or moderate hypospadias, single stage surgery is the norm worldwide but for severe hypospadias only a very small number of centres perform a single stage surgery worldwide. At Hypospadias Foundation, we routinely perform single stage repair of scrotal hypospadias whenever possible and this is the case in almost 80% of scrotal hypospadias. The main deciding factor is the curvature (chordee) of the penis. If the chordee is very severe requiring a ventral graft or transection of urethral plate, then we do a staged repair else our intent is to perform a single stage repair in even scrotal hypospadias.
Master A.S., was born preterm with a birthweight of only 1.8kg. He was noted immediately at birth to have a severe scrotal hypospadias. Fortunately both his testis were descended normally and were of normal size. He passed urine well and was recommended to have a pediatric urologist/ surgeon evaluation at 1 year of age in Bhopal (MP),. Parents wrote to us at Hypospadias foundation when the boy was 2.5 years of age to ask us our opinion for Hypospadias treatment. We asked them to send some pictures and videos via email so that we could analyse the type of hypospadias and understand the type of hypospadias correction surgery needed. Finally, the family travelled from Bhopal to Mumbai for treatment. One examination, A.S. had a scrotal hypospadias and the penis had only a mild chordee. Both the testis were normally descended. We elected to perform a single stage hypospadias repair for him. We deployed a Transverse Prepucial onlay island flap urethroplasty for the hypospadias repair. A 4 cm long flap was raised from prepuce and hypospadias was corrected in one stage. The surgery took about 2.5 hours and the child was allowed feeds after 3 hours of surgery. We discharged him to home the next morning. The hypospadias dressing was removed on day 5 and catheter on day 10. A.S. healed well and passed urine from tip. After another follow-up one week later, the family travelled back to Bhopal, Madhya Pradesh and sent us pictures after one month and three months after hypospadias surgery. Though there was some minor stitch reaction near head of penis but it gradually subsided and now after 6 months of surgery, A.S. is doing very well and does not need any further surgery.
Parents sent us a thank you email and here it is:
“Our son’s hypospadias condition was picked up immediately at birth by our neonatologist. Needless to say, that we were devastated, as we realized that our little bundle of joy was already lined up for surgeries in the coming years. We consulted many urologists however; when we met up with Dr. Arbinder Singal at MITR hospital all our fears were allayed. Many doctors had suggested two stage surgeries, we were assured by Dr. Singal that though our son had one of the severe kinds (scrotal hypospadias with chordee); he would be just fine after a single stage surgery. He is quite a diligent urologist as he patiently explained to us our son’s condition, the procedure that our son required and what exactly would Dr. Singal be doing in the long 4 hr procedure. For us the most comforting factor was that Dr. Singal is not only a pedatric urologist but also a meticulous surgeon who is an expert in this domain. Once completely convinced, we admitted our son in the morning of the surgery at MITR hospital. I must say that the facility is well equipped to handle such cases. The resident doctors, nursing staff, orderlies are very cordial, helpful and attentive to the needs of the patients as well as the anxious parents. The post- operative care that has been given to our son is commendable as they have patiently attended to all alarms and issues of the kid. We highly recommend Dr. Singal and MITR for urology related issues especially hypospadias surgery”
These emails of happiness after good results of hypospadias surgery are priceless to us. These affirm our faith that however complex the hypospadias maybe, we must try to repair in single stage. Most of them indeed do well after one stage surgery for hypospadias.
About Hypospadias Foundation, India
Hypospadias Foundation is an organisation dedicated to care of children and adults with hypospadias. Located in Navi Mumbai, in western India, we see more than 200 kids and adults with hypospadias for treatment every year and the numbers have steadily grown. More than 25% of all patients are failed hypospadias referred from all across India and 10% of our patients travel from other countries to come to India for best hypospadias treatment and surgery results. The specialists for hypospadias surgery- Dr A.K.Singal and Dr Manish Dubey, make sure that the patients benefit from their expertise in managing hypospadias.
To contact Hypospadias foundation, you can either write to us at email@example.com or fill up this contact Form
Watch Videos of Hypospadias Repair surgery procedure by Dr A.K.Singal, Specialist Hypospadias Surgeon
Posted in Cases worth noting,Hypospadias Specialist,Hypospadias surgeon India,Success Stories | Posted by Dr. A K Singal | Posted on May 19, 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
Hypospadias remains the most common urological anomaly in boys and more than 1 lakh kids are born in India every year with Hypospadias. Majority of these are mild variety like glanular, coronal, distal penile or midpenile hypospadias. Less than 15% of all hypospadias are moderate to severe variety of hypospadias like proximal penile, penoscrotal or scrotal hypospadias. While very mild hypospadias like glanular or coronal without chordee may be left alone without surgery, all other types of hypospadias or those with chordee require hypospadias correction treatment.
There are more than 100 different types of hypospadias surgery techniques described in medical literature attesting to the fact that none of the techniques are perfect or suitable for all types of hypospadias. The hypospadias specialist surgeon needs to be well acquainted with anatomy and various techniques to decide the type of surgery needed in a particular hypospadias case. Subtle variations in anatomy decide the type of technique needed. Hence the decision for each hypospadias is very individualized.
The common techniques in use for primary hypospadias are TIP urethroplasty (Snodgrass repair), Mathieu repair, Onlay Island flap urethroplasty, Prepucial tube and staged Bracka’s urethroplasty. Each technique of hypospadias surgery has its own advantages and disadvantages and case selection becomes very important.
Case: Boy from Lucknow
Master A.C. was born with proximal penile hypospadias in Lucknow. He was advised surgery after one year of age by the doctors in Lucknow. They consulted various surgeons in Lucknow and Delhi but were not satisfied by the approach. Finally, the boy’s uncle who was a scientist in CSIR sent an email to Hypospadias Foundation with all records and pictures asking for an opinion. We advised a clinical examination and a single stage surgery. The family flew to Mumbai and saw us in MITR Hospital, Kharghar where Hypospadias Foundation is located. The penis size for Master A.C. was very small with a stretched penile length of 2 cm and Glans diameter of 11mm. We advised two injections of Testosterone (male hormone) to induce growth of penis at one month interval. After one month of second injection, the glans size increased to 15.5 mm and penis length to 29mm. At this time, we planned a hypospadias correction surgery. A.C. was admitted the morning of surgery and a single stage urethroplasty was done using Onlay Island Flap technique for which Dr Singal is very renowned. The surgery took 90 minutes and the boy was discharged the next morning after hypospadias surgery. The dressing was removed after 5 days and catheter was removed after 10 days. A.C. passed urine well and at one month follow-up was passing urine in a good stream without any issues. The penis has healed very well with an excellent cosmetic result. The parents were overjoyed and sent an email of thanks after one month from Lucknow. Further follow-ups will be via email and phone calls. Patients from across the globe follow-up with us using electronic medium such as email, whats app and skype.
Testosterone (hormone) injection before Hypospadias surgery
In some cases of hypospadias the penile size may be small and the head of penis (glans) may be very tiny. In such cases it is difficult to repair the hypospadias adequately. We advise testosterone injections in dose of 25mg intramuscular injections two months and one month before surgery. The testosterone injections help in two ways: Increasing the size of penis and glans; secondly the blood supply (vascularity) of the foreskin increases which helps in making a good flap in severe hypospadias. Two doses of testosterone injections do not have any short term or long term side effects on body growth etc. Part of the effect of testosterone on penile growth is reversible but part increase in size of penis is permanent. For us at Hypospadias foundation, we give Testosterone injections for babies where the penis size is less than 25mm or the glans diameter is less than 13-14mm.
Onlay Island flap urethroplasty
Onlay island flap urethroplasty is a type of hypospadias repair surgery where a flap is made from foreskin on the top of penis (dorsal prepuce) and brought on underside of penis. This flap is based on a robust blood supply from dartos tissue of the foreskin (see the video below). Onlay island flap urethroplasty is reserved for severe hypospadias or where the TIP repair is not suitable and the chordee is not very severe. In hands of expert hypospadias surgeons, Onlay Island flap urethroplasty offers best results in repair of severe hypospadias. Dr A.K.Singal is one of the best hypospadias surgeon specialists in India for such surgeries. Dr Singal has been invited at various national and international conferences to showcase his surgical technique (see video below). Every year more than 200 children and adults with primary or failed hypospadias are operated under his team’s care in Navi Mumbai, India.
If your child has a hypospadias and you wish to get in touch with Dr Singal for treatment, you can fill up the contact form below or you can see him at one of his hypospadias clinics in Navi Mumbai or Mumbai. You can also call up Dr Rajkumar, Co-ordinator for Hypospadias Foundation at +91-9821261448 between 9am-6pm to discuss any queries.
See Video of Proximal penile hypospadias repair using Onlay Island flap technique- by Dr A.K.Singal
See Scrotal Hypospadias repair using Onlay Island flap urethroplasty- by Dr A.K.Singal
Posted in Hypospadias Specialist,Hypospadias surgeon India,Hypospadias surgeon Mumbai,Hypospadias surgery video,Hypsoapdias Surgeon delhi | Posted by Dr. A K Singal | Posted on March 4, 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
Hypospadias remains one of the most common urological anomalies across the globe affecting almost 1/150 newborn boys. No nation or economic status or religion is exempt from its occurrence. The art and science of hypospadias treatment has evolved significantly in the last two years with a single stage repair of hypospadias a real possibility in most of the cases. The results of hypospadias surgery are of course better at centres where there are specialist hypospadias surgeons doing dedicated hypospadias treatment in large numbers every year. Even the complications of hypospadias surgeries decrease significantly with increasing experience. This was the aim with which we started Hypospadias Foundation in 2008. Now 6 years later, we are happy to provide excellent outcomes and give happiness to kids and families who travel to India from all over the world.
The Child from Great Britain
Master Narain was noted to have hypospadias as soon as he was born in England. The pediatrician advised the family to meet the pediatric surgeon or pediatric urologist when the child was three months old. Through the NHS system, the family went and met a Pediatric Surgeon who advised hypospadias repair surgery after 1.5-2 years of age.
Mother and father, both UK residents, were worried about delaying the surgery so much as somehow they felt that once the surgery is needed they better get it done at a younger age than a later age. They just couldn’t understand the point of waiting for the surgery which would anyway be required. With this dilemma about the age for hypospadias surgery, they contacted us at Hypospadias Foundation. After a few tele and online consultations they decided to travel to India for Hypospadias repair surgery with us at MITR Hospital in Navi Mumbai, India. We advised surgery between 6 months to one year of age. Finally, when Narain was 9 months old they traveled to India from England and visited us.
On examination, Narain had a distal penile hypospadias without any chordee. The urethral plate was pink and healthy and he seemed suitable for a single stage Hypospadias repair. Parents did not have too many questions and I was very surprised. When I asked, they said that they have read a lot of blogs written by me on hypospadias treatment and were upto date with what their son is going to go through. This was a very happy consultation indeed. Saved me time and energy but still I went through the pre and post hypospadias surgery routine with them explaining to them. They just nodded their heads and posted Narain for surgery one day later and meanwhile we got the blood/ urine tests and pre surgery fitness for anesthesia.
Surgery was done as first case in the morning the following day. Surgery was done under caudal analgesia and sevoflurane anesthesia. Since the urethral plate was good and the hypospadias was not very severe (distal penile hypospadias), we did a Tubularised incised plate urethroplasty also called Snodgrass repair urethroplasty. The surgery took only 75 minutes. Narain tolerated the procedure well and was to his usual playful self in a few hours after surgery. We sent him home by the next morning on usual oral medications for pain and bladder spasms and a mild antibiotic. One week later, the family visited us again in the outpatient clinic for removal of dressing and catheter. Narain passed urine well without any issues and had a good healing operative site at the time of hypospadias dressing removal. Another followup was scheduled at 10 days after catheter & dressing removal. Narain was passing urine in a good straight stream without any difficulty. Also the cosmetic result was excellent. The family was overjoyed and was able to travel back to England within three weeks of surgery. We requested the family to send us a short video of Narain passing urine and a few pictures of his penis at about 6 weeks and 3 months after surgery to confirm that everything has healed without any complication. We received these videos and pictures a week back and were happy to note that there was no complication of the surgery. We expect Narain to do very well and live a normal life after the hypospadias surgery.
About the author:
Dr A.K.Singal is a renowned Pediatric urologist and is considered one of the best hypospadias surgeons in India. He treats more than 100 kids with hypospadias every year at various hospitals in Navi Mumbai, Thane and Mumbai. Lot of kids travel from neighbouring cities such as Pune, Ahmedabad, Surat, Goa and as far as Bangalore, Hyderabad, Calcutta, Delhi, Jaipur, Chennai etc.
He can be contacted by filling up the form here: Contact form Dr A.K.Singal
Watch Video of Distal Penile Hypospadias Repair Surgery by Dr A.K.Singal, expert hypospadias surgeon
Watch Video of Single stage surgery for severe scrotal hypospadias by Dr A.K.Singal, Hypospadias specialist surgeon
Posted in Hypospadias Specialist,Hypospadias surgeon India,Hypospadias surgeon Mumbai | Posted by Dr. A K Singal | Posted on January 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
Hello Dr A.K.Singal,
My feedback from my baby’s operation at Hypospadias Foundation & MITR hospital in Navi Mumbai, Kharghar, sector 21:
When I was told by my baby’s doctor at the time of birth that he had hypospadias, we were very worried about it as it was the first time I had heard such case. Then I started searching about treatment and could not find any specialist locally in Afghanistan. Then we searched for a hypospadias specialist in India and could find the best pediatric urologist surgeon in Mumbai called Dr. A. K Singal in MITR hospital in Navi Mumbai although, I searched in Delhi and other states. Indeed what all I found it was just from Google net and I was really not sure what is going to be happen. Many questions arose into my mind that how the operation is going to be done? How many days my son would be admitted? And many other questions were there.
Eventually, I got appointment with the MITR hospital via email with Mrs. Emily Paul who was very helpful and then we decided to go India for the treatment and finally reached the mentioned hospital on the 1st December, 2014. In the same day, Dr. A. K Singal visited my child and he impressed me when he talked about the operation and we decided to operate him after two days. Then on the 3rd December my baby’s operation was done.
The operation was done in a very professional way and successfully with no issue. Then I realized that I took a really right decision and found the right hypospadias doctor. It was amazing that in the same day my baby did not have any pain and discharged from the hospital but I requested to remain for some more days for betterment of the child.
We (me and my wife) have very good memories from the Hypospadias Foundation and MITR Hospital especially from Dr A.K.Singal and now we know why he is a renowned Pediatric urologist and one of the best Hypospadias surgeons in India. The staff of Hypospadias Foundation based in MITR Hospital is good and the nurses were really outstanding. I thank them too.
My little angel is doing very well after surgery with no issue and we overcome those all tensions and worries which we had in the past. I really appreciate Dr. A. K Singal and whole MITR team with professional communication and cooperation and your friendly environment.
Considering that our son had hypospadias which can have lot of stigma, we request you to keep his name and identity confidential. We would be happy to interact with parents whose children are suffering from hypospadias any time offline.
Thank you Dr. Singal.
Mr M.H., Herat, Afghanistan
Master F.H.,8 months old child underwent distal penile Hypospadias treatment at our hospital recently (Dec 2014). Father had written to us about a month back expressing a desire to travel for Afghanistan to India for the hypospadias repair surgery. They had sent us pictures of the penis via email and we could explain to them the type of anomaly and the surgery needed for the same. Fortunately, the father took very good and clear pictures as instructed and it was easy for us to understand even without examining the child. Ms Emily Paul and Dr Rajkumar coordinated the OPD appointments and then one fine day the baby was at our hospital in Navi Mumbai. We confirmed the hypospadias to be distal penile hypospadias and did the pre surgery checkup and fitness by a Pediatrician. We took up the baby for surgery on 03/12/2014 and surgery was done using Tubularised Incised plate urethroplasty (TIP repair) also called Snodgrass repair or Snodgrass urethroplasty. Originally described by Dr Warren Snodgrass, the TIP repair is one of the most reliable and common repairs done worldwide for distal and midpenile hypospadias in selected and suitable cases.
The surgery was finished in one hour and F.H. was allowed feeds after 3 hours of surgery. He was at his playful best by evening and we planned to discharge the baby. Parents were very worried about taking him to a hotel and requested to stay in the hospital for another week till the dressing and the catheter were taken out. In normal circumstances, we discharge most of the hypospadias surgery kids by evening of surgery but here understanding the situation we allowed them to stay for a week. Finally the catheter and the dressing were removed in 5 days and the parents took the child to Pune with them. I saw them on 15th Dec 2014 once again before their final flight back home to Afghanistan from Delhi. He was doing very well and the penis had healed very nice with good cosmetic and functional outcome.
Staff and nurses were very fond of master F.H. as he was a very happy baby and used to come to everyone’s arms easily and used to play with them. He used to be in my lap all the time. All of us here at MITR Hospital and Hypospadias Foundation wish him the very best in life. And we all miss him.
About the Hypospadias Foundation & Dr A.K.Singal
Hypospadias Foundation in Navi Mumbai, India is the world’s only organisation committed and dedicated to treatment and care of children having hypospadias. Over last 6 years children from all over India and from more than 15 countries have benefitted from care at Hypospadias Foundation.
Dr A.K.Singal, Pediatric Urologist and Hypospadias Surgeon is an expert and renowned surgeon for management of children and adults with Hypospadias. Dr Singal and Dr Manish Dubey are close friends and together started Hypospadias Foundation in Nov 2008.
Dr Singal can be contacted by filling up this form: Enquiry form for Hypospadias
Or you can call up Dr Rajkumar (Dr Singal’s assistant) at +919821261448
His clinic timings in Navi Mumbai, Thane and Mumbai are available here:
Hypospadias repair surgery videos by Dr A.K.Singal:
Posted in Hypospadias Specialist,Hypospadias surgeon India,Hypospadias surgeon Mumbai,Hypospadias Surgery,Hypsoapdias Surgeon delhi,Success Stories | Posted by Dr. A K Singal | Posted on December 26, 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
Hello Dr. Singal,
When we came to know our son is suffering from hypospadias, we being parents were
really worried for him. There were several doubts and fears running in and out through our mind. We were very tensed and concerned regarding his hypospadias repair surgery, overall result and further treatment.
We then visited many doctors in Pune but were unhappy and unsatisfied with their answers and process of treatment, until one day while surfing on internet we read about you and the hypospadias foundation run by you. Thumbs up for the great job you are doing by running this foundation and providing complete awareness among parents.
For first time when you examined our son and the manner you explained the entire
process of surgery and treatment, really raised positive hopes in us. Most of our doubts were cleared in the first meeting itself. We want to thank you from the bottom of our heart for undertaking our son’s surgery not only in positive way but also making it successful in the first stage. Due to your fair treatment and kind support we were able to cope with our son’s surgery and health. We really want all other parents as well whose children are suffering from hypospadias to undergo Hypospdias treatment at Hypospadias Foundation at MITR Hospital, Navi Mumbai and go back home smiling.
As our son is a hypospadias patient, we want to keep his name and identity confidential. We are ready to share our experience and contact details with the parents whose children are suffering from hypospadias any time offline.
Mr. & Mrs. K,
These letters are priceless to us. As a hypospadias surgeon, I owe it to our team for excellent results and patient happiness. Surgery is often just one of the things which makes successes and miracles happen. It is the larger picture – the dedication, thought process, commitment and most importantly the love which the surgical team can give. I can safely say that beyond the surgeon’s hands and nurses injections there is something else which cures a patient. It is love and faith and it runs both ways. Mr and Mrs K came and saw us three months back and they came with full faith and commitment to get their son better. It is not easy to get a surgery for your young child. It is much more easier to get surgery done for yourself rather than your child. I really wish to express my gratitude to the parents and families who give their little ones in our hands trusting us to do the right thing for their child.
Case summary for Master D.K.
Master D.K. was born with scrotal hypospadias and was advised by the pediatrician to see a pediatric urologist or a pediatric surgeon for Hypospadias repair surgery at 1-2 years of age. After multiple consultations elsewhere, they finally came to see us at MITR Hospital & Hypospadias Foundation in Navi Mumbai. Navi Mumbai is just 2 hour’s drive from Pune so family thought of taking a second opinion from us.
Examination of Master D.K. confirmed severe scrotal hypospadias with mild chordee. I counseled the family regarding the possibility of a single stage repair. I explained to them that our intent would be to repair the hypospadias in one stage but sometime 5-10% of the kids may need a second surgery if something doesn’t heal well after first surgery. D.K underwent hypospadias repair surgery in October 2014 using an Onlay Island Flap Urethroplasty. He recovered from surgery and anesthesia very fast and was walking around and eating normally the next day. Happy with his recovery from Hypospadias surgery, we discharged him the next day and he went home back to Pune the day after surgery. Dressing was removed after 5 days and urinary catheter a total of ten days after surgery. A follow-up visit after 2 weeks showed hypospadias repair site to be healing well and parents and we were both very happy to see. It is now almost two months after surgery and D.K is doing very well. I hope that he continues doing well though he will need follow-ups at three months, one year then at 5, 10,15 years of age as some minor issues can crop up later in some cases of severe hypospadias.
As of now, it is time to rejoice and I can also breathe a sigh of relief. And to top up the happiness, I got this letter from the parents, which makes all the hard work so much worthwhile. Such letters make my work a pleasure and operation theatre a playground. My best wishes to the family for a happy future for the kid.
About the Author:
Dr A.K.Singal is a renowned Pediatric urologist and one of the best Hypospadias surgeons in India. He is the founder of Hypospadias Foundation based in MITR Hospital, Navi Mumbai and regularly does hypospadias repair surgeries in Mumbai, Thane and Navi Mumbai.
To contact Dr Singal- pls fill up this form- Contact form
Videos of Hypospadias Surgery by Dr A.K.Singal
Posted in Hypospadias Specialist,Hypospadias surgeon India,Hypospadias surgeon Pune,Pediatric urologist pune | Posted by Dr. A K Singal | Posted on December 12, 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
Besides 100,000 kids born in India every year with hypospadias, there are an estimated 5-10 lakh adults living with either unoperated hypospadias or failed hypospadias having complications of Hypospadias surgery. These can be minor issues such as urethral fistula, chordee or suboptimal cosmetic results but a significant number may have major issues such as completely failed hypospadias, urethral diverticulum, hairy urethra, urethra stricture etc. Unable to come to terms with penile deformity, they do not get any hope or assurances from adult urologists or plastic surgeons as this may not be the area of primary interest or dedication for them.
Mr Rajveer Singh, 30 years old man, had a midpenile hypospadias with chordee and was operated by a plastic surgeon in Hissar Haryana 2 years back. After surgery, there was a breakdown of hypospadias repair and he was still passing urine from underside of penis. He was still having a downward curvature of penis (chordee) even after this surgery. Also he had seen hair growing out of urinary opening over last few months. He was very worried as he wanted to get married, hence he wrote to us asking for help. We wrote back asking for detailed pictures on email which would help us in understanding his clinical condition and hypospadias deformity. Finally, we called him to see us at Hypospadias Foundation in Kharghar, Navi Mumbai. He took a flight from Delhi to Mumbai and landed up in my Hypospadias clinic on a Monday evening. On examination, he had a urinary opening much below the head of penis in midpenile region and also a couple of holes (urethral fistula) from where he was leaking urine. More importantly his penis still looked bent due to uncorrected chordee. Lastly the cosmetic outcome was really bad with tags of skin here and there and we could see hair coming out of his urethra due to previous failed improper hypospadias surgery. This results when an undertrained hypospadias surgeon uses hairy penile skin for urethral reconstruction. We counselled Rajveer regarding the surgical plan the first step of which would be excision of all unhealthy skin tissue on underside of penis, chordee correction (straightening of penis) and then decide for the type of hypospadias repair in operation theatre. This would be either a single stage repair using a local flap from hairless penile skin or a staged repair using a buccal mucosa graft. In staged buccal mucosa graft – we first excise all unhealthy tissue and scars of failed hypospadias repair, then take a thin lining from inside of lower lip or cheek and then place it as a graft on underside of penis. Once this graft gains local blood supply from penis tissue, we roll it into a urethral tube typically after 6 months of first stage. We always keep buccal graft as the last option in failed hypospadias as that essentially means multiple surgeries. Hence, we attempt to do a single stage flap repair whenever feasible even in failed hypospadias and hence we shared this intent with Rajveer.
Rajveer was taken up for surgery the next day under spinal anesthesia and first a cystoscopy was done. It showed normal urethra beyond midpenile region and unhealthy scarred hairy urethra with fistulae in the distal penile region. We excised all the unhealthy tissues and then checked for chordee. There was still 30 degrees bend in penis which needed correction by a 12 O’clock non-absorbable stitch on the top side of penis. On rechecking with artificial erection, there was no chordee now. After chordee repair was satisfactory, we analysed the penile skin on the right side of penis. We could see an island of hairless skin which was possibly remnant of foreskin (prepuce). We designed a long flap from this with very good blood supply from the underlying dartos tissue. This flap was used in an onlay fashion to repair hypospadias in a single stage. Finally head of the penis (glans) was also repaired and a catheter was placed to drain urine till the whole repair healed. Rajveer went back to his home town in Haryana after 3 days of surgery and then we arranged for one of my surgeon colleagues in Hissar (Dr Vivek Gupta) to help with post hypospadias surgery care. The catheter was removed on day 14 since it was a major hypospadias reconstruction. Rajveer passed urine well and but the full healing of the penis took about 4 weeks. The final cosmetic result was excellent when he sent the pictures via email. He visited us recently almost 3 months after surgery, the penis looked well healed and he is passing urine well from the tip in a good stream. His erections are straight and he is now looking forward to get married. The only question is whether he will invite me for his wedding or not and if he invites, how will he introduce me.
When such complex failed cases do well after hypospadias treatment at Hypospadias foundation, it makes us very happy. We feel our goal of starting the foundation in Nov 2008 has been fulfilled. Last six years have been a long and exciting journey but is has been a very challenging time. When we started we never knew the burden of problem was so high. Along the way we have been privileged to be a part of lives of more than 600 kids and adults with Hypospadias from all over India and some countries abroad. Almost 25% of those receiving treatment at Hypospadias Foundation, have been patients with failed hypospadias who received surgery elsewhere. Though initially we started only with management of hypospadias in children but we realized that there is huge gap when it comes to treatment of hypospadias in adults. Along with Dr Manish Dubey, my close friend who is an adult urologist we are able to offer good care and success rates in adults and failed hypospadias.
In last three years, Hypospadias Foundation has welcomed many patients from many other states and countries such as Nepal, Bangladesh, Greece, Afghanistan, Iraq, Saudi Arabia, UAE-Dubai, Oman, Great Britain (UK), USA, Nigeria, Tanzania, Kenya, Congo, Zambia and this number continues to grow attesting to our devotion to the field of Hypospadias. Within India, kids and their families have travelled for treatment of hypospadias from Assam, Kolkata, Orissa (Puri, Bhubhaneshwar), Ranchi, Chattisgarh (Raipur, Katni), Gujarat (Ahmedabad, Surat, Baroda, Gandhinagar), MP (Indore, Bhopal), Himachal, Delhi, Haryana (Hissar, Rohtak, Panipat), Rajasthan (Bikaner, Jaipur, Jodhpur), Maharashtra (Jalgaon, Pune, Aurangabad, Nasik, Nagpur, Parbhani, Dhule, Solapur, Kolhapur, Ahmednagar, Ratnagiri), Uttar Pradesh (Lucknow, Allahabad, Meerut), Goa, Andhra Pradesh (Hyderabad, Belgaum, Guntur), Uttarakhans (Dehradun), Jammu, Kerala (Cochin), Tamilnadu (Chennai, Salem, Coimbatore) and Punjab (Chandigarh, Ludhiana and Patiala).
About the author:
Dr A.K.Singal is a Pediatric Urologist and Hypospadiologist practicing in western india in area of 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 is available at the following clinics :
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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
Watch video of Distal penile hypospadias repair surgery by Dr A.K.Singal
Posted in Adult hypospadias,Failed & redo Hypospadias,Hypospadias Specialist,Hypospadias Surgery | Posted by Dr. A K Singal | Posted on November 12, 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