Dr. A.K.Singal, Author at Hypospadias Foundation

March 03 2015

Hypospadias repair surgery in adults: Man from Nepal gets successful treatment at Hypospadias Foundation, Navi mumbai, India

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 (18^th 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 with adult hypospadias patient from Nepal after a successful outcome

Hypospadias repair surgery in adults:

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.
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.
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.
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.
Abstinence from sex: We advise abstinence from sex and masturbation for almost 3 months after hypospadias surgery in adults.
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.
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

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

March 03 2015

In search for a cure for Hypospadias: From Lucknow to Navi Mumbai, India

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.

Dr Singal with Family from Lucknow

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.

Dr Singal’s clinics and Timings

Contact form for Dr Singal & Hypospadias Foundation

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

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

February 02 2015

Boy from Congo (Africa) finds cure for Distal Penile Hypospadias in Navi Mumbai, India- Successful hypospadias repair surgery even after circumcision

Hypospadias is the most common urological anomaly (birth defect) seen in newborn babies worldwide. It is mostly diagnosed soon after the baby is born when the opening of for urine is seen to be on underside of penis, the foreskin (prepuce) is incomplete on the underside and there may be a bend in the penis (chordee). Very rarely, if the hypospadias is very mild, it can be missed on neonatal examination by even a pediatrician.

Lot of countries and religions practice and advocate newborn circumcision in all male babies but whenever hypospadias is diagnosed in newborn age, circumcision should not be done. During circumcision, the prepuce is cut off and a very vital tissue which is required for hypospadias repair surgery is lost. Prepuce or its layers are used for anatomical hypospadias correction surgery. In a circumcised boy, hypospadias repair becomes difficult and complication rate of hypospadias surgery is little higher.

Master K.Hadriel.Ileunga was born in Congo (Africa) in a small city. His doctor did not recognize at birth that he had a distal penile hypospadias. He underwent a circumcision in the first few days of life by a general practitioner doctor. Later his parents and doctors realized that Hadriel had a distal penile hypospadias. As he grew up in Congo (Africa) his parents worried about his hypospadias. They visited a few doctors in Congo but there was no pediatric urologist available in Congo who could do a hypospadias repair after circumcision. At this time, they learnt about Hypospadias Foundation in Navi Mumbai, India and sent an email to come and get treated under Dr A.K.Singal’s care, one of the most renowned pediatric urologists and the best Hypospadias Surgeon in India.

Finally in first week of Jan 2015, the family met Dr Singal in Navi Mumbai. On examination, Hadriel had a distal penile hypospadias without chordee. There was no prepuce as he had undergone a circumcision in newborn age. After discussing with the parents, Hadriel was taken up for Hypospadias repair surgery on 16 Jan 2015. The surgery was done using Tubularised incised plate urethroplasty – also called Snodgrass urethroplasty. The whole urethroplasty was completed in one stage. The child was discharged from hospital the next day and the hypospadias dressing was removed after 5 days. The urethral catheter was removed after one week of surgery. Hadriel passed urine in very good stream without any difficulty. After a final follow-up two week after surgery, Hadriel has gone back to Africa- his country Congo and family is very happy. Fortunately, he had an excellent result of hypospadias repair surgery even after a neonatal circumcision.

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Watch Video of Single stage surgery for severe scrotal hypospadias by Dr A.K.Singal, Hypospadias specialist surgeon

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

January 01 2015

Family travels from England (UK) for Hypospadias repair surgery of their child to Navi Mumbai, India

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

Dr A.K.Singal during Hypospadias surgery

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

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

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