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 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
