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

January 01 2019

A child with multiple Failed Hypospadias surgeries finds cure at Hypospadias Foundation with Staged Buccal (oral) mucosa graft urethroplasty

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias is very common congenital birth defect of penis. Most of these children require surgery in childhood. The accepted rate of complications after hypospadias repair in less than 20% in sever and under 10% in milder distal or midpenile hypospadias. When the first surgery for hypospadias fails, the children may need a second redo surgery and in some cases third or more surgeries. Such cases are best managed and treated by expert hypospadias surgeons or hypospadias specialist doctors.

Master AKM was born in Mumbai India. He was noted to have severe proximal penile hypospadias. He underwent one hypospadias repair at the age of 5 years and another one at 8 years of age. He developed pain in passing urine and used to really cry at time of passing urine. The treating surgeon at a top mumbai hospital, tried to open the urethra by taking under anesthesia and dilating 3-4 times but the symptoms of pain while passing urine returned again and again.

Finally, the parents came to Hypospadias Foundation in Navi Mumbai and contacted us. The child was attended to by Dr A.K.Singal, Pediatric urologist & hypospadias surgeon. On examination, Master AKM had pus at the new opening of penis which was little under the head of penis even after previous multiple surgeries. The penis skin also looked unhealthy and hard at places. The child was admitted and given antibiotics by injections. Parents were explained about the serious condition and that cystoscopy will be needed to check the reason for child’s difficulty in passing urine.

During cystoscopy, it was realized that the new urethra made during surgery had all become very tight (Stricture). The urethra beyond penile region was also unhealthy till bulbar region near prostate gland. A condition called BXO (Balanitis Xerotica Obliterans) was suspected as the cause of the stricture. Dr Singal discussed with family for the need to open the entire urethra till prostate gland and then put skin from inside the mouth on underside of penis (Buccal mucosa) and then come and do the second stage surgery after 6 months. The parents agreed for the plan for staged buccal (oral) mucosa graft urethroplasty.

The urethra was opened on the underside of penis till bulbar region. Long buccal mucosa graft was harvested from right inner cheek. Since a long graft was needed, another buccal graft was taken from the lower lip (labial oral graft). For the proximal urethra- cheek buccal graft was placed as dorsal inlay graft and urethra was closed till penoscrotal region. From Penoscrotal region till glans- buccal graft from lip and cheek was placed, fixed and left open. A tie-over dressing was done to fix the graft and help in graft uptake.

After 6 months, the graft looked pink, healthy and soft. Second stage urethroplasty was finished over 8 Fr catheter as the graft and surrounding tissues looked supple now. Dressing was removed on day 5 and catheter was removed on day 10. AKM passed urine well after catheter removal with excellent healing of the tissues. We did a uroflowmetry to check flow of urine, it showed an excellent flow rate of 25ml/ sec. AKM remains well after two years of surgery and is growing up to be a smart young man. He and his family have put up all bad memories behind them and are keen to help other families who have kids suffering from hypospadias.

About buccal mucosa graft urethroplasty:

Buccal (oral) mucosa is inner lining of mouth (Cheeks, lips) and is a very good layer to be used for redo surgery in failed hypospadias. Buccal mucosa urethroplasty (also called oral mucosa graft) is recommended when there is shortage of skin on the underneath of penis and there is no residual prepuce (foreskin). Hence, buccal grafts have no role in primary or first surgeries for hypospadias.

Parents often get very worried and alarmed when we as hypospadias surgeons tell them that we will take the skin form the mouth to make urine passage in penis. The reasons are:

Buccal (oral) mucosa has excellent healing properties
Buccal mucosa is soft elastic and is used to wetness
It never grows hair when put inside penis.
Buccal mucosa does not get BXO
Graft sites heal very fast and child can eat normally in a day or two
There is very small chance of any cosmetic deformity as the skin is taken from inside, there is no cut outside the mouth.
Like any other graft, once taken from mouth and placed on penis – it takes new blood supply. Hence, it is better to wait for 6 months before doing the next surgery, in cases where a large graft has been taken.

About the author:

Dr A.K.Singal is a renowned Pediatric Urosurgeon and one of the best hypospadias surgeons in India. At hypospadias Foundation in India and Bahrain, he takes care of more than 150 kids and adults with primary and failed hypospadias. Hypospadias foundation is located at MITR Hospital in Kharghar, Navi Mumbai, India and at Ibn Al Nafees Hospital, Manama, Kingdom of Bahrain.

With the team work, expertise, dedication, a bit of luck and years of experience in treating patients with complex, severe and failed hypospadias, at Hypospadias Foundation we are able to give them cure and their normal life back.

To contact Dr Singal, Submit your enquiry here: http://www.hypospadiasfoundation.com/contact-form-for-patients/

September 09 2018

Hypospadias Foundation starts Clinic in Bahrain

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias surgery is a very delicate, specialised and rare surgery. It requires years of training, very special interest, and dedication to get good results from hypospadias surgery. Often the first surgery is the best hope for cure from hypospadias; once there is a failure at first surgery, subsequent surgeries become difficult and results poorer. Hence, it is recommended that hypospadias treatment should be conducted only by trained pediatric urologists and hypospadias surgeons. To provide such specialized care, the Hypospadias Foundation starts Clinic in Bahrain, ensuring expert treatment for hypospadias patients.

At Hypospadias Foundation in India, hundreds of children come from all over the world to seek treatment either for primary or for failed hypospadias. Children from more than 20 countries have benefitted from surgical expertise and caring attitude of team at Hypospadias Foundation located at Navi mumbai, India.

Many these children come from middle east, Gulf/ GCC countries and MENA region to India. While we get more than 50 enquiries a month from countries such as Bahrain, Saudi Arabia, Oman, UAE (Abu Dhabi/ Dubai), Qatar, Kuwait, Iran, Iraq, Jordan, Kenya, Tanzania, Nigeria – many of them find it difficult to come to India as some of these children may require multiple surgeries if the hypospadias problem is complex or they have failed surgeries elsewhere.

Sensing this acute gap in quality of hypospadias care, Hypospadias Foundation has started a Pediatric Urology and Hypospadias Clinic offering consultations and surgeries in Bahrain. The centre is located at Ibn Al Nafees Hospital in Manama, a renowned hospital with good facility and excellent reputation for good quality care of children.

The Hypospadias and Pediatric urology centre will offer consultations, diagnosis, pre and post-surgery care, surgery for various Pediatric urology disorders including hypospadias. The centre is run jointly by Dr A.K.Singal, Hypospadias Surgeon & Pediatric Urologist from Mumbai, India and Dr Mahmood Abbas, Senior Pediatric Surgeon trained in France and living in Bahrain.

Dr A.K.Singal is considered as one of the best hypospadias surgeons worldwide. Every year he treats kids from all over the world for primary, severe, complex and failed hypospadias. Dr Singal’s experience in Hypospadias surgery is one of the largest single surgeon hypospadias treatment experience in the world.

Dr Singal said,” Every month we receive enquiries via email from children of parents living in Gulf, Middle East and MENA region for hypospadias. It is indeed cumbersome and expensive for them to travel to India for surgery and treatment of hypospadias. Our association with Ibn Al Nafees hospital, Manama, Bahrain will offer them care and surgeries for hypospadias within a more accessible and familiar location in the beautiful country of Bahrain. The centre will also focus on offering treatment for other child urology conditions such as hydronephrosis, reflux, infections, incontinence, undescended testis (cryptorchidism), megaureter and kidney stones.

Dr Mahmood Abbas added, “Myself and Dr Singal have formed a team to start Hypospadias and Pediatric Urology Clinic at Ibn Al Nafees Hospital to ensure that children with hypospadias and pediatric urological conditions get the best treatment. Even children who have failed earlier hypospadias surgery, can be managed with advanced surgery and novel techniques.”

Here is how to contact Hypospadias and Pediatric Urology Clinic at Ibn al Nafees Hospital, Manama, Bahrain:

Address:

Ibn al Nafees Hospital,

Rd No 3302, Manama, Bahrain

Appointments:

Dr Mahmood Abbas

Ibn Al Nafees Hospital

Phone: +973-17828246, 28247, 23209

By Whatsapp: +973-39467333

Email:

Hypospadias.bahrain@gmail.com

Fill up contact form: https://www.hypospadiasfoundation.com/contact/

July 07 2015

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

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

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

July 07 2015

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

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.

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

Previous page 1 … 7 8 9 10 11 … 19 Next page

Author Archives: Dr. A.K.Singal