Single stage hypospadias repair surgery video for a child with failed hypospadias: Nagpur to Vellore to Navi Mumbai, India

Posted on July 17, 2015 by Dr. A K Singal

Like every other surgery, hypospadias correction surgery has its own risks, complications and failures. Inspite of the best intentions and efforts of the parents and the treating hypospadias surgeon, still the results may be sub-optimal after the first surgery. Though at the end of hypospadias surgery in OT it may seem that the surgery has gone very well, sometimes there may be minor complications which necessitate a second surgery for hypospadias in some children. The rate of second surgery for a complication or failure of first hypospadias surgery decrease with the expertise and experience of the hypospadias surgeon but it is never zero and that is an important thing for the parents and families to understand.

When the first surgery for hypospadias fails, parents get very disturbed and start looking for more information on why it happened and the solutions and second opinion for hypospadias to help fix the problem. Most of the times, the primary surgeon may be the best person to solve the problem but sometimes the complication may be severe and in such cases the patient should be referred to a centre of excellence in hypospadias surgery.

While minor problems like fistula or cosmetic issues can be treated easily with as second minor surgery- major complications of hypospadias surgery such as urethral breakdown, dehiscence, urethral diverticulum or stricture may require more complicated or even a staged repair with grafts. Hence, the dictum- that first surgery for hypospadias is the best surgery- further surgery if the first one fails is always more difficult and challenging.

At Hypospadias Foundation, we regularly receive kids and adults from all over India and other countries who have had a failed hypospadias surgery elsewhere. Families request for a second opinion for the hypospadias treatment and we advise them comprehensively. Some of these cases really benefit from the specialist care offered by a dedicated hypospadias team.

Case Story

Master A.G., a 3 years old boy, resident of Nagpur, underwent a surgery for a proximal penile hypospadias surgery at a hospital in Vellore. Unfortunately, the healing was not optimal and the whole repair had a breakdown. After 6 months of previous surgery, the family wrote to us and visited us at our centre in Kharghar, Navi Mumbai. On examination, the child has proximal penile meatus with mild chordee. There was a remnant of foreskin (prepuce) on the underside of penis. There was no foreskin left on the topside of penis. We explained to the parents that this may require a two stage repair but we will try out best to make a flap from the residual foreskin and do the surgery in one stage.

Finally after pre-surgery tests and fitness assessments, we took the child for redo-hypospadias surgery. We could make a nice onlay flap out of the foreskin remnant by carefully dissecting the blood supply and preserving the supply to this flap skin. The flap was used to make the new urethra in one stage as it can be seen in the video below.  The surgery took about 3 hours and the child was allowed feeds four hours after surgery. The dressing was removed after 7 days and catheter after 10 days. The hypospadias site healed very well and the child was examined again after 1 month. He was passing urine well in a single stream from the tip of penis. Now, 6 months after hypospadias repair, A.G. continues to do well and his parents are very happy and we are also overjoyed to achieve a good result in this challenging failed hypospadias case. The detailed hypospadias surgery video can be watched by clicking below. Besides the story mentioned here, the video below shows another child story from Raipur, Chattisgarh where the first surgery resulted in a penile torsion and a large fistula. The child underwent a successful single stage surgery at Hypospadias Foundation:

Watch Video of Failed Hypospadias surgery by Dr A.K.Singal

About Hypospadias Foundation

Hypospadias Foundation is an organisation dedicated to care and cure of children and adults suffering from hypospadias and Disorders of Sex development (DSD). Hypospadias is a unique penile urological birth defect and requires complicated and skillful surgery. The results of hypospadias surgery improve with dedication and the number of surgeries a hypospadias surgeon does every year. Besides surgery, a proper selection of the technique and care of the child before and after surgery also matters.

Since its inception in 2008, our dedicated team at Hypospadias Foundation has cared for a large number of children and adults with hypospadias from across India (practically all states) and more than 20 countries. Dr A.K.Singal, Dr Manish Dubey, Dr Rajkumar , Emily Paul, Dr Ajit Baviskar, Naina along with anesthesia team and other staff make sure that every patient with hypospadias receives compassionate care and cure.

Dr A.K.Singal

If you or your loved one has hypospadias and wish to seek an opinion, please write to us at hypospadiasfoundationindia@gmail.com or contact Dr Rajkumar- Coordinator at +91-9821261448 between 10 am-5pm India Time.

You can also fill up this contact form: Contact Hypospadias Foundation

or come to MITR Hospital in person after taking an appointment by sending an email at frontdesk@mitrhospital.com or calling up at +91-22-27743558/ 4229 or +91-9324180553

Watch Video of proximal penile hypospadias correction by Dr A.K.Singal

Watch Video of scrotal hypospadias repair by Dr A.K.Singal

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

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Posted in Failed & redo Hypospadias,Hypospadias surgeon India,Hypospadias surgery video,Success Stories | Posted by Dr. A K Singal | Posted on July 17, 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

A little boy from Bangladesh takes a little bit of India with him: Successful Distal Penile Hypospadias Repair Surgery in Navi Mumbai

Posted on July 10, 2015 by Dr. A K Singal

We are privileged to care for children from across the world who come with their parents to our Hypospadias centre in Navi Mumbai, India looking for the best in Hypospadias surgery and treatment. The love and affection which we give to the kids is a mirror image of the trust and faith which family puts in us. It is the simple rule of medical care and cure.

Happy kids= happy parents = good results= happy surgeon who sleeps well. Our nurses and junior doctors almost adopt the kid as one of theirs and then play with the kid during recovery time and we see that with such a personalized care the kids recover after hypospadias surgery in no time.

Somebody said it aptly, “When you are happy the time flies very fast”. Hence, if everyone remains happy and in high spirits after a hypospadias surgery, time just disappears. Long journey to India and time spent here seems worthwhile.

The Email from Dhaka, Bangladesh:


Dear Sir,

Here is our testimony. As you know we are from Dhaka city in Bangladesh and when our son, baby Satyaki Sarkar, was born, he had a problem which the doctors named distal penile hypospadias. So when doctor told us about this problem we were very worried. We didn’t know what to do because we never heard the name of such type of problem. I searched in internet about the problem for best doctor for hypospadias. After searching internet we got the address of Dr. Arbinder Singal, Hypospadias specialist surgeon and Hypospadias Foundation in Navi Mumbai, India. We also watched the video of hypospadias repair surgery which they had uploaded related to surgery about hypospadias of a baby. We also studied the articles of Dr. Singal and others hypospadias surgeons around the world. After that we finally decided to do the hypospadias repair surgery in Navi Mumbai India, at MITR Hospital & Hypospadias foundation. We contacted with the authority of Hypospadias foundation for getting appointment. Ms. Emily Paul and Dr. Rajkumar Gupta arranged appointment for us in a cordial way.

Now it was time for hypospadias surgery. We met with Dr. Singal on 21st March. He appointed us on 23rd March for operation. We were so tensed about Satyaki’s operation. But Dr. Singal and his team were so cooperative that we forgot about all tensions and focused only on Satyaki’s operation. At last, on 23rd March, 2015, the hypospadias operation was done successfully without any problem. After having surgery we stayed in the hospital for one day and the next day they discharged us. After having surgery we felt that we came in the right place because my baby had no surgical pains. He recovered so quickly that we couldn’t imagine. We realized that best results are possible after hypospadias surgery.
We would like to specially mention about the nurses and staffs of hypospadias foundation. They were so cooperative, and cordial. They can manage the babies with hypospadias after surgery in a very caring and professional way.
Now my little boy is completely recovered and doing well without any problem. You may post the picture of my baby and us which you have to us. Because we think that this may help to realize the families that hypospadias problem may be solved through proper surgery. We also think that through our message and picture many families who are suffering from this problem will get new aspirations and hope.
At last we again want to give thanks to Dr. Singal and his team for doing this surgery in an excellent way. We wish success of this foundation in every step of its life.
With best regards

Sanjeev Kumar Sarkar
Father of Satyaki Sarkar
Dhaka, Bangladesh.

Dr A.K.Singal

Satyaki Sarkar after successful hypospadias surgery with his family and Dr Singal


Case Details: Master Satyaki had a coronal hypospadias, a variety of distal penile hypospadias. He did not have any chordee and his urethral plate was good quality. Hence, we elected to perform a TIP (Tubularised Incised Plate urethroplasty, also called Snodgrass repair). The surgery was completed in one hour’s time and Satyaki was allowed feeds two hours after surgery. He recovered well from anesthesia and surgery and was planned for discharge the next day. In the usual course of family living nearby, we could have sent him home the same day also but since the family had travelled all the way from Bangladesh we kept them in hospital for overnight observation and then they shifted to a nearby hotel. Hypospadias dressing and catheter was removed 5 days after surgery and a final examination done 10 days later showed everything to be well healed and Satyaki was passing urine very well from his new opening at the tip of penis. Now at three months after surgery, Satyaki continues to do well and surgical team is delighted with the outcome of surgery.

While most of families may be little concerned about sharing their personal details etc, Mr Sarkar was very gracious and himself offered to share pictures and details to lend authenticity to the story. He felt this will encourage the parents to think positively about hypospadias treatment in their children. Our endeavor at Hypospadias Foundation of providing good personal and surgical care to children stands fulfilled when we get testimonial and review emails like this one.

About Hypospadias Foundation:

Hypospadias Foundation is a centre of excellence for treatment of children and adults having hypospadias. The centre is located within MITR Hospital at Kharghar, Navi Mumbai India and is the best hospital for treatment and care for patients with hypospadias and associated problems including DSD. The team is led by Dr A.K.Singal, a renowned Pediatric urologist surgeon and an excellent hypospadias surgeon. He is supported by Dr Manish Dubey who helped Dr Singal start Hypospadias Foundation and is himself a renowned Urologist. Every year more than 200 kids and adults travel to Navi Mumbai for care and treatment of Hypospadias. If you wish to contact us, you can write to us at hypospadiasfoundationindia@gmail.com or call Dr Rajkumar, Coordinator for Hypospadias Foundation at +919821261448 between 10am-5pm, India time.

You can also click here and fill up the contact form and we will answer your query as soon as possible

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

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

Watch Video of severe scrotal hypospadias repair by Dr A.K.Singal

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Posted in Hypospadias surgeon India,Success Stories,Uncategorized | Posted by Dr. A K Singal | Posted on July 10, 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

A child from Bhopal (Madhya Pradesh) gets successful result of scrotal hypospadias in a single stage urethroplasty at Hypospadias Foundation, India

Posted on May 19, 2015 by Dr. A K Singal

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.

Dr A.K.Singal

Dr A.K.Singal with Happy kids

 

To contact Hypospadias foundation, you can either write to us at hypospadiasfoundationindia@gmail.com or fill up this contact Form

Contact Hypospadias Foundation

Watch Videos of Hypospadias Repair surgery procedure by Dr A.K.Singal, Specialist Hypospadias Surgeon

 

 

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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

Chennai to Navi Mumbai: A Doctor’s tale of Hypospadias Repair Surgery for her son

Posted on April 6, 2015 by Dr. A K Singal

As doctors we are blessed to earn both money and gratitude from our patients. This is even better for us Pediatric urologists as we can experience deep happiness of the parents when their little one gets better after a surgery. We personally feel that we are a part of their life now as we were the lucky one’s to be there when they were struggling to get their little one through a difficult time such as surgery. God has given such unique position to doctors caring for kids as they can then see kids growing up year by year and feel blessed to have invested their life into building up a healthy and safe future.

The diagnosis of hypospadias in a newborn baby can cause a lot of anxiety, distress and pain to the mother who has just delivered, the husband who hasn’t slept in days and the family which has keenly waited for 9 months. At this time in first few days of life, if a proper counseling and guidance can be given by an expert, it can make a world of difference. This may not be possible all of the times as surgeons caring for children with hypospadias on a very dedicated basis are far and few in between across India. Most of the pediatric urologists and surgeons are adept in diagnosing, understanding and counseling for hypospadias and hence should be called in neonatal age itself.

One year back, I received a call from neonatal nursery to see a newborn baby born with hypospadias. Both mom and dad were doctors and worked in Chennai, Tamilnadu, India. Mother was delivering in a Navi Mumbai hospital as the maternal side family lived in Vashi. During the visit, I could see the anxiety and concern writ large on her face. She was torn between playing her role as a mother and her knowledge as a doctor. I discussed with her in detail about the type of hypospadias and also the corrective surgery needed. Since it was a midpenile hypospadias, I told them that a single stage urethroplasty repair was possible. We discussed at length about the right age for surgery and anesthesia. The baby and mother were discharged from nursery at 3 days and then I saw them again at 1 month of age, By this time, the mom was mentally tough and ready for the surgery. We planned the surgery at 6 months of age.

The family travelled from Chennai to Navi Mumbai at 6 months of age with a preplanned date for surgery. Since the urethra was hypoplastic for a short distance proximally and the urethral plate was not very good, we did an onlay island flap repair. The surgery was completed in 2 hours and A.J. was discharged the next morning. The hypospadias dressing was removed on day 5 and the urinary catheter was removed on day 10 after surgery. A.J. healed well over next 2 weeks and the family visited me again 6 months after surgery. A.J. is passing urine from tip of penis, the penis is straight and there is an excellent cosmetic result of his hypospadias surgery. The family is overjoyed and I am also relieved and happy with the good outcome.

The mother sent us a nice thank you note last week and it made my day. It follows verbatim here:

Hello Dr. Arbinder Singal,
A happy parent with a blessed son.
First I would like to convey my heartily thankfulness for your key role in my life. I would rather tell it as my life because my son is my life.
October 2012, good news was accompanied with sad news too, when my pediatrician told me that my son is suffering from hypospadias. Even though I am also a doctor, a fearful alarm rang inside a mother with loads and loads of questions.
But to my rescue doctor, your opinion was asked. During your visit, you were polite and calmly answered all my questions and relieved my fears.
As I am from Chennai and my parents stay in Chennai, everything fell in place very conveniently.
After 6 months, the day for hypospadias surgery came, as doctors, my husband and I were ready mentally but emotionally it was a nightmare.
But thank you doctor, MITR doctors and staffs- All made us feel very comfortable. You were so supportive and took care of everything right from the beginning.

That day gave a new life to my son. Now he is doing fine and leading a happy and normal life.

Six months have passed and everything is well.

Thank you God
Thank you doctor
Thank you MITR Hospital and staff
Thank you Hypospadias foundation
May your sincere service continue forever for the needy.
God bless you
Yours
A happy parent with a blessed son

Footnote:

These are the letters and emails which make caring for kids worthwhile even in the face of all risks and uncertainties of surgery on a small child. In the dark times, these blessings shine like rays of hope and give energy to carry on. I wish to express gratitude to all parents who have trusted us with the care of their little ones. We feel truly blessed and honoured to be of help.

About the author:

Dr A.K.Singal is a Pediatric Urologist and a specialist hypospadias surgeon. He does more than 200 hypospadias repair surgeries every year and has the best results for complicated and failed hypospadias. Every year he gets referred complex, severe and failed hypospadias patients from all over India and more than 20 countries. Along with the team at Hypospadias Foundation and MITR Hospitals, he feels joy and blessings in caring for children with hypospadias.

Dr A.K.Singal

You can send us an enquiry by filling up this form: http://hypospadiasfoundation.com/contact-patient.htm

Or you can send us an email at hypospadiasfoundationindia@gmail.com

Or you can call Dr Rajkumar, Coordinator of Hypospadias Foundation, at +91-9821261448 between 10am-4pm

Videos of Hypospadias Repair surgery by Dr A.K.Singal

 

 

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Posted in Hypospadias surgeon India,Hypospadias surgeon Mumbai,Hypospadias Surgery,Success Stories | Posted by Dr. A K Singal | Posted on April 6, 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 repair surgery in adults: Man from Nepal gets successful treatment at Hypospadias Foundation, Navi mumbai, India

Posted on March 22, 2015 by Dr. A K Singal

Hypospadias is the most common urological birth defect occurring in upto 1/150 newborn boys, which measures upto almost 100,000 (1 Lakh) new cases every year. While most of the cases are not hereditary or genetic, 6-8% of hypospadias cases have family history of hypospadias or associated genetic disorders. In the current era and in cities, most of these children are referred to pediatric urologists or surgeons in early childhood and receive timely treatment for hypospadias. This was not true 20 years back or even now in many parts of the world. Hence, there are a large number of adults living with hypospadias across the world either unrepaired or some who have failed hypospadias surgery in childhood. In India alone, there are an estimated 5 lakh adults who have either not received hypospadias surgery or have failed hypospadias surgery in their earlier years and their families or they themselves have given up.

Every year, we receive adults from many countries in South East Asia and rest of the world who travel to India to Hypospadias Foundation to find treatment for their Hypospadias problem. Recently, a young man travelled from Nepal for hypospadias treatment. We would like to share the story.

Reaching Hypospadias Foundation:

Mr N.S. was born with hypospadias and was diagnosed soon after birth. Due to lack of knowledge and pediatric urology/ hypospadias specialists in Nepal, his parents could not get him treated for hypospadias in childhood. He grew up to be a smart boy and completed his graduation and got employed with an infrastructure company in Nepal. But somewhere at the back of his mind he had this nagging doubt about treatment of his hypospadias issue. He kept on searching whether he can get treatment with good results for hypospadias at the age of 23 years but no one gave him a satisfactory answer. Finally he contacted Hypospadias Foundation at Navi Mumbai, India- a team of hypospadias surgeons led by Dr A.K.Singal and Dr Manish Dubey. He sent his medical records by email and also some pictures. After an electronic opinion, he finally travelled to Navi Mumbai in September 2014.

Examination:

Mr N.S. was examined by Dr A.K.Singal, Pediatric urologist and expert Hypospadias surgeon in Hypospadias Clinic at Hypospadias Foundation, Navi Mumbai, India. He was found to have distal penile hypospadias with mild chordee. No previous surgery had been done. The midline raphe of the penis was misaligned to one side causing a slight bend in the penis also to one side called penile torsion. N.S. was counselled for surgery as well post-op recovery and underwent distal penile hypospadias repair surgery (urethroplasty) the next day.

Hypospadias Repair surgery:

Since it was a case of primary hypospadias and there was no previous surgery done, the urethral plate was still preserved well. We planned to do a single stage TIP repair (Tubularised Incised plate urethroplasty or Snodgrass repair). The new urinary tube (urethra) was made over 12 Fr silicon catheter and covered with two additional layers for secure healing and prevent fistula. First layer was with corpus spongiosum called spongioplasty and second was with dartos from foreskin on the top of penis. Finally excess foreskin on top was excised imparting a circumcised look to the penis. N.S. was discharged the day after surgery on antibiotics, analgesics (painkillers), antacids and antispasmodics. Additionally a medicine was given to decrease erections temporarily. One week later, we removed the dressing in clinic and finally the catheter was removed on day 10. N.S. had some pain initially on passing urine but within 2-3 days he was passing urine normally from the tip of penis. There was an issue with delayed healing of skin on underside of his penis which finally healed completely in 2 months. He has been passing urine normally and came to see us at 6 months follow-up after surgery this week (18th March 2015) and was extremely happy with the result of hypospadias repair surgery. He has healed well with a single stage surgery and does not require any further surgery. He is planning to start seeing girls now and get married soon. We have given him a clearance to go ahead with marriage and send him our best wishes from Hypospadias Foundation.

Dr A.K.Singal, Hypospadias Specialist, India

Dr A.K.Singal with adult hypospadias patient from Nepal after a successful outcome

Hypospadias repair surgery in adults:

  1. Longer healing time than children: Though the overall success rates of hypospadias surgery in adults remain good and comparable to hypospadias surgery in children, the healing takes longer. It may take upto 2-3 months for the penis skin to heal fully though one can start passing urine normally in 2-3 weeks.
  2. Longer time for indwelling catheter: We like to keep catheter inside for 10-14 days for distal hypospadias repair in adults and 14-21 days for severe hypospadias repair in adults. This is in to children where most of the catheters are removed in 5-10 days.
  3. Higher risk of infections: Since there is hair growth in penile area and more sweating in adults, the chances of skin infections at hypospadias surgery site is little higher in adults.
  4. Pain after surgery: As adults have night time erections during a certain phase of the sleep, there may be episodes of severe pain during healing phase in first one month. Hence we give medicines to decrease the frequency of erections for 4-6 weeks and stronger pain killers.
  5. Abstinence from sex: We advise abstinence from sex and masturbation for almost 3 months after hypospadias surgery in adults.
  6. Off from work: Since most of the adults are in a job or business, it is important to take atleast 4 weeks off from work before planning hypospadias surgery.
  7. Uroflowmetery: We recommend performing a test called uroflowmetry to check the speed of urine passage at 3 months and one year of surgery to make sure that the new passage is of good caliber.

Conclusion

Though there are challenges in treating adults with hypospadias, but with diligence and dedication very good results can be achieved at Centres of Excellence in Hypospadias Treatment. A good counselling, a thorough OPD consultation are a must before embarking on the surgery to ensure that the adults with hypospadias understand the treatment, results and long term outcomes. This also helps in setting the expectations right after Adult Hypospadias surgery.

About Hypospadias Foundation

Hypospadias foundation is the World’s first and only organisation dedicated to care of children and adults suffering from Hypospadias. Founded by Dr A.K.Singal and Dr Manish Dubey in Nov 2008, more than 700 children and adults have found hope and cure at Navi Mumbai India. Kids and adults travel from all over India and now more than 20 countries to Navi Mumbai for state of art treatment, surgery for hypospadias and best results. The unique teamwork between a pediatric and adult urologist allows adults with hypospadias to gain the best results in treatment of hypospadias. Hypospadias Foundation can be contacted at hypospadiasfoundationindia@gmail.com or +91-22-22743558/ 4229 Oor Dr Rajkumar, Coordinator for Foundation can be contacted at +91-9821261448 between 9am- 5 pm India time.

Or you can fill up this enquiry form: Enquiry Form

 

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Posted in Adult hypospadias,Hypospadias surgeon India,Success Stories | Posted by Dr. A K Singal | Posted on March 22, 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

Letter from Afghanistan: 8 month old child undergoes successful hypospadias repair surgery at Hypospadias Foundation in Navi Mumbai, India  

Posted on December 26, 2014 by Dr. A K Singal

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.

Best Regards,

Mr M.H., Herat, Afghanistan

Case description:

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 A.K.Singal

Dr A.K.Singal during Hypospadias surgery

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:

Clinics and Timings for Dr Singal

Hypospadias repair surgery videos by Dr A.K.Singal:

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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

Living with Hypospadias- Adults with hypospadias

Posted on January 30, 2014 by Dr. A K Singal

The tale of hypospadias does not stop in first few years of life for everyone. This is especially true of adults and adolescents who underwent hypospadias surgery repair using older techniques and with lesser trained Hypospadias surgeons 15-20 years back. While a majority of these have done well, there is a sizable population of adults in India who have persistent issues secondary to hypospadias such as urethral fistulas, persistent penile chordee (bending of penis), urethral stricture or bad cosmetic outcome. As Pediatric urologist and a surgeon with deep interest in hypospadias (hypospadiologist), we keep seeing such patients on a regular basis now.

There are atleast estimated 5 lakh adults/ adolescents in India with untreated, complicated or residual issues of hypospadias in India. Some of these people live an unsatisfied life thinking that no cure is possible because that is what they have been brought up to think. Individuals who have failed multiple surgeries are called Hypospadias cripples in medical community signifying the crippling effect which inadequately treated hypospadias can have in a person’s life.

Fortunately, with newer techniques, better hypospadias surgery instruments, very good sutures like PDS, availability of dedicated hypospadias surgery teams and expert hypospadias surgeons good results are possible in any patient with previous failed hypospadias surgery even in hypospadias cripples.

Here is story in point:

Six months back I saw Mr RK, a 30 year old young man, who had been a case of failed hypospadias – operated for hypospadias twice in his childhood in a hospital in Delhi. Both the surgeries had met with partial success and his parents had left him like that and lost hope at a completely functional urethra. RK had been a good student and went on to do Engineering graduation from IIT and then a MBA from Pune. He had taken up a job in multinational company and now was planning to get married. Infact, he had delayed marriage inspite of a successful career because he was never satisfied with outcome of his hypospadias surgery. That’s why he looked up on internet and came to see us at Hypospadias Foundation in Navi Mumbai.

At the first consultation itself and being in relatively the same age group, we hit it off really well and he was quite frank and objective about his condition and that kind of interaction helps a hypospadias specialist like me. When I examined him, he had a persistent mild chordee but the bigger issue was his urinary opening (meatus) was not on the tip of penis (glans penis) but way down in distal penile location. He had many skin bridges and scarred islands of skin and a large urethral fistula in proximal penile region. There was a bit of penoscrotal transposition as well. On questioning, he was passing 50% of the urine from the urethral fistula and 50% from the distal penile location without any straining and in good urinary stream. None of these problems were major by themselves and could have been cured easily but after two failed hypospadias repairs in childhood, I think parents just gave up hope.

So we discussed with RK at length about the various things which needed to be done-

  • Distal urethroplasty using flap from nearby ventral penile skin,
  • Closure of urethral fistula (fistula repair) in multiple layers with tunica vaginalis flap
  • Correction of penoscrotal transposition
  • And chordee correction by dorsal plication.

The surgery was done next week at MITR Hospital & Hypospadias Foundation. Dr Manish Dubey, Urologist and Co-founder of Hypospadias Foundation helped me with the surgery and management immediately post surgery. RK was sent home the day after surgery. A follow up visit for hypospadias dressing removal was planned on day 5 and catheter removal o day 10.

Some of things especially in adults undergoing hypospadias surgery, which we took care of to ensure smooth recovery and are different from children:

  • Postoperative pain and erections
  • Choosing the right urethral catheter and drainage bag

We were also worried about higher chances of wound infection and bleeding after redo-hypospadias repair. For pain and prevention of erections we gave benzodiazepine derivative tablets and phenobarbitone along with diclofenac and that helped pretty well for two weeks. For the catheter, we used a Foleys silicon catheter for 10 days and left it to drain in a urine bag which RK could carry with him and walk around within his home.

Fortunately, everything went well and now after 3 months of hypospadias surgery, the hypospadias surgery site is healing well and there is no more pain during erections. The urine stream is good and RK is passing from the tip of his penis for the first time in his life standing like a normal man. He is not shy to use the public toilets anymore- He just stands up and delivers.

We have asked him to wait for three more months before planning marriage and these three months he is actually going to spend in finding the right girl for himself. For him, we hope the chapter of HYPOSPADIAS is closed now.

The only question remains whether as a Hypospadiologist I will get invited to his marriage- if yes, how will he introduce me? As the doctor who fixed his penis? I think that is too much and I will just skip attending his marriage and I wish him the best of luck always from our side and from everyone at MITR hospital and Hypospadias Foundation in Navi Mumbai, India.

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Posted in Adult hypospadias,Failed & redo Hypospadias,Success Stories | Posted by Dr. A K Singal | Posted on January 30, 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

Don’t give up hope on Failed Hypospadias

Posted on November 3, 2012 by admin

This is an interesting and inspiring story and I thought I will share it with everyone who has an interest in the field of hypospadias.

About 6 months back, a 14 years old boy was brought all the way from Nasik to my Pediatric Urology clinic at MITR Hospital in kharghar, Navi Mumbai. The parents did not seem to very well educated and were from a farming background. The father was in some class 4 government job. I was wondering why they would travel for 8 hours to a small place like kharghar to see me. Also the age seemed to me a little bit older than the usual age which I see in my clinic. I was intrigued.

The boy seemed little uncomfortable and had furtive glances here and there. Parents and relatives were fidgety too. The consultation began – I asked what brought them to Kharghar. They said that their kid has hypospadias and has undergone 5 surgeries till now but still passes urine from below. I asked them “how did they find me”. They said maternal uncle of the boy knows internet and found me while looking for information about hypospadias. So there it was Internet the great enabler at play.

I went through the case records dating 10 years back. The kid was born with scrotal hypospadias and underwent first major surgery at 2 years of age to straighten the penis (chordee correction) at a top medical college at Mumbai. Post that there were multiple attempts to make a new passage initially using native penile skin and then lining of urinary bladder twice and finally skin graft. Everything had failed and the last surgery was about 5 years back when it was told that there is no hope of the boy having a normal urethral opening at tip of penis. Now I knew the reason of furtive glances and fidgety mannerisms.

On examination, the boy had the urinary opening right near the anus, the penis was still slightly bent (chordee) and there was lots of scarring on underside of penis with deep pits and ragged skin edges. Further there seemed to be a couple of blind passages and left testis also looked higher in position, may be it was caught up in the scar process. Since the opening was even behind the scrotum, the child had to sit in the toilet and pass urine. Overall, the case seemed like mother of all hypospadias.

I counseled the parents and set out a planned staged correction of hypospadias. I told them it will be tough and they will need to be patient and have faith.  The plan was to bring him back to his original anatomy first and the reconstruct the entire new urinary passage. As the first stage, I planned to remove all the scarred skin and straighten the penis. In the raw area thus created I was planning to put buccal mucosa graft which is nothing but the inner layer of skin inside the mouth more specifically lips and cheeks. This buccal mucosa graft takes about 3-4 months to heal and then we planned to use this patch to create a new urinary passage. This would give a sure result and the buccal mucosa graft being moist and soft would not have any issues being in touch with urine. Also there would be no hair growth inside the passage in the future.

Well, the parents were convinced because probably I was the first hypospadias surgeon to offer them any hope. So we all set out on our task, an uphill journey.

We took up VW for first stage surgery – expecting about 4 hours of surgical time. But we ended up consuming about 7 hours by doing the following

  • Cystoscopy and ascertaining usable urethral passage
  • Excision of all scar tissue on underside of penis
  • Straightening the penis – chordee correction
  • Closing the perineal urethrostomy and establishing a penoscrotal meatus.
  • Correcting the penoscrotal transposition
  • Left orchioexy was needed as the left testis was caught in the fibrosis
  • Buccal mucosa graft

But we were satisfied at the end of it all. We could not think of a shortcut as the child had been through a lot. The child remained in the hospital for 7 days and the graft healed very well. At removal of catheter, he was able to pass urine from the penoscrotal meatus without difficulty and was finally able to stand up and pass urine without wetting his pants. I could see the change in his behavior and he seemed more interactive now with me and the hospital staff. We had moved forward by an inch I guess!

4 months later we admitted him again for second stage urethroplasty. The previous graft had healed very well. We could easily make a new urethra just rolling the previous graft plate. This was done over a 12 French silicone catheter without any stress. To ensure full healing we also used a tunica vaginalis graft from the right testis to cover up the suture line.

As I write, the child has finished one month follow-up after urethroplasty surgery and is recovering well from the surgery. He is passing urine currently from the tip meaning the repair is holding well. The final result is yet to be seen and may be another minor procedure may be needed but the journey has been great. Our mood is upbeat and we are sure that we will reach the destination this time or another short journey may be needed 3 months from now. The fact of the matter is that we enjoyed the journey.

It is challenges like these when everyone else has given up, we still gear up and try to do our best for these kids. We may not pass in one attempt but eventually we will. Even if 20% need another surgery that is still acceptable as the final goal can still be achieved.

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Posted in Success Stories | Posted by admin | Posted on November 3, 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