For a child with Hypospadias, the first surgery is always the best surgery but still there can be complications and failure even in expert hands though complications are much less if operated by a surgeon or a centre where there is a focused practice in treating children with hypospadias. Literature and experts suggest that if a hypospadias surgeon is doing more than 50 hypospadias repairs in a year, then his results will be better and more predictable as compared to a general pediatric surgeon or a urologist who does only 10-20 hypospadias repairs in a year. Once a hypospadias surgery fails, then the next surgery becomes more difficult and result less sure. The failure rate of hypospadias surgeries vary from 5% to 50% depending on the type and severity of hypospadias in general centres and less than 10% in centres where hypospadias surgeries are done by expert hypospadias surgeons on a day to day basis.
Case details
Master A.P. was born with a distal penile hypospadias and underwent first surgery in Ahmedabad at the age of 6 years. Unfortunately, the surgery failed and he developed a urethral fistula – a condition in which the child starts passing urine from the underside of penis somewhere from the repaired new tube. The new urinary passage through the head of the penis got tight and closed off. The surgeon tried to open it many times by catheter insertion but it failed. Coupled with failed hypospadias, there was also an unsatisfactory cosmetic appearance with bunching of foreskin on underside of penis. With this situation they contacted us at Hypospadias Foundation in Kharghar, Navi Mumbai when the boy was ten years of age. After examining we advised an Onlay island flap repair with use of flap from bunched up skin on underside of penis. This repair is technically challenging because of previous surgery but this was the only chance for the boy to have a single stage repair. The surgery for failed hypospadias was finished in 2 hours and on day7 and he passed urine well from the tip of penis. The healing was complete in next 3 months. At 15 years of age and after his 10th standard exams, A.P visited us and had a big smile on his face. He is looking forward to higher education and he shared with us his dreams and further education goals. We plan to see him again one last time at 18 years of age. His penis growth and his functional & cosmetic outcome has been excellent so far.
Letter of thanks from the father:
Dear Dr Singal,
My son A.P was operated first for hypospadias at Ahmedabad. The hypospadias problem actually worsened and we were very tense about my son’s future life. While searching through internet I came to know about you and your colleague doctors.
From your past surgeries and mastery about Hypospadias surgeries we decided and contacted you before surgery. At Mitr hospital, from the first meeting with you, we were confident about our son’s second Hypospadias surgery and we decided to do it only with you.
At Mitr Hospital, we experienced very good pre and after surgery treatment from Doctors and staff also, very good and polite staff. At Gujarat we don’t have such experienced and professional hospital staff. I think this is also very important besides doctors. I feel that if the doctors are not confident they must not try and go ahead for these surgeries because once it is fails, the situation of patient and his family is unbearable. It creates psychological problems also and these can be very stressful to handle. Thanks to your team, my son is doing well now.
Regards
M.P., Gandhinagar, Gujarat.