There are a large number of adults living with unrepaired hypospadias or failed hypospadias surgery in childhood across the world. 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. 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.
Case story:
Mr N.S. was born with distal hypospadias and due to lack of knowledge and pediatric urology/ hypospadias specialists in Nepal, his parents did not get his hypospadias treatment in childhood. He completed his graduation and got employed with an infrastructure company but somewhere at the back of his mind he had this nagging doubt about treatment of his hypospadias issue. 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.
Since it was a case of primary distal hypospadias and there was no previous surgery done, 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. 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. At 6 months followup in March 2015, he had healed very well and was passing urine normally 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. We have given him a clearance to go ahead with marriage and send him our best wishes from Hypospadias Foundation.
Hypospadias repair surgery in adults
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 Hypospadias surgery.