Category Archives: About Hypospadias

One of the common questions which the parents ask in clinic when we counsel them for surgery on hypospadias is “how many days will it take for my kid to recover after hypospadias repair surgery.”

And our answer as expert Pediatric Urologist & Hypospadiologist, though very detailed, could be read two ways.

One, we are avoiding a straightforward answer and the second may be that we want to give a deeper and more enriching answer which clears all the doubts and answers the question in its whole entirety.

The recovery can be discussed along many dimensions:

The immediate and the most concerning is the Recovery from anesthesia and this usually occurs within 2-3 hours after surgery implying that the kid will be able to talk, converse and start taking liquids etc after hypospadias surgery. Usually after 4hours of surgery kids can take solid foods and normal diet. We have made sure that our operation theatre, surgical and anaesthesia protocols are child friendly to make sure that the recovery is fast, and kids go home fast. The anesthesia used is caudal plus sedation in most cases which allows for pain free recovery post hypospadias repair. We also keep a warming mat under the child during surgery to prevent low body temperature, the anesthesia team is trained in managing small babies, and all the equipment for anesthesia and surgery is baby friendly.

• Pic 1: Dressing immediately after surgery.Recovery to playing and walking usually happens by evening of hypospadias surgery and often we find kids fully comfortable and running around on the same day by evening or by the morning of day after surgery. That’s also the reason why we moved from bulky dressings and bags- avoiding these and using a double diaper method of managing kids after surgery allows them full freedom of movement. It is during this phase that all the hospital staff at MITR Hospital make sure that the child is well cared for and parents are made comfortable during the stay.

  Recovery from dressings & catheter takes more time. After hypospadias surgery, dressing is usually changed after 7 days and catheter after 7-14 days, depending upon the complexity of hypospadias repair. In some distal hypospadias we remove the dressings and catheter at the same time which is at first follow up visit one week of surgery. This saves unnecessary visits to the hospital. The overall intent is to make hospital visits for the kids as less as possible. For adult hypospadias repair, catheter may need to be kept as long as 3 weeks.

• Pic 2: Hypospadias surgery site inspection at week 1 after surgery

• Pic 3: Hypospadias surgery site inspection at week 3 after surgeryRecovery to a new urethra in the larger sense of passing urine through the new passage happens when the child starts passing urine comfortably which can be expected 2-3 days after removal of the hypospadias catheter. For the first two or three days there may be little bit of pain in passing urine through the newly formed urethra.

  The final recovery happens when the swelling of the penis subsides, the sutures get absorbed and the penis assumes its final shape and thus one can see the cosmetic outcome. This time which the swelling takes to go away may be variable but usually takes up to a month after hypospadias surgery. Especially in kids after hypospadias surgery or urethroplasty, sometimes the penis looks black, blue, swollen and bruised and yet after a month or so everything looks so normal as if just a circumcision has been done.

  Penis is an organ which tends to swell up at the slightest excuse be it a minor infection, injury and as hypospadias surgery involved major cutting and stitching, penis does swell up significantly after hypospadias surgery. Equally importantly the penis is also an organ which heals very fast. Hence, almost normal skin cover comes back even after an extensive hypospadias repair in which a lot of penile skin gets rearranged.  Sometimes the penile skin looks very raw and incomplete for some days after surgery but when the patients finally come back after a month it looks like no surgery was done as the skin of penis has an amazing regenerative capacity. Partly this is because of an extensive blood supply of penis skin and partly because of the loose specialized skin.

  We have started using specialized Tegaderm and light gauze dressings.

  Tegaderm is a transparent cling wrap kind of dressing which is very easy to take off and gauze piece is made of soft cotton which is rolled around penis for 3-4 turns and then held with a micropore tape. One more throw of the tape also helps in holding the catheter in place after surgery. These tapes are easy to take off in outpatient clinic mostly by junior staff. The catheter is held by a small fine stitch to the glans, and this can be easily cut in outpatient clinic to remove the catheter.

  The hypospadias dressing which we do at our centre does not impair the blood supply as the pressure exerted by such dressing on an already swollen penis is quite less. Also, a loose dressing decreases the chances of pain especially when erection happens at night.  Our dressings also allow tissues to breathe and have good circulation after urethroplasty.

  At hypospadias foundation, every year we treat more than 250 children and adults with hypospadias. Children and adults from more than 25 countries visit our hypospadias foundation center in search of cure for hypospadias. Very few centers all over the world have achieved excellence in hypospadias and we are one among them. We are dedicated in treating hypospadias and want to help kids and children suffering from hypospadias.

  Dr. A.K. Singal is a renowned and top Pediatric Urologist practicing in Navi Mumbai. Dr. Singal’s passion and expertise in Hypospadias led him to establish the hypospadias foundation in 2006. The Hypospadias Foundation is the World’s First and India’s only hospital dedicated to caring for children and adults with hypospadias. It is considered as the best hospital for hypospadias surgery in India.

  Dr Shenoy along with Dr Singal aim to provide world class surgery and treatment for children and adults with hypospadias and DSD. They have helped more than thousands of children and adults with hypospadias from all over the world.

  If you or your child has hypospadias and you wish contact Hypospadias foundation, the you can contact us by following methods:

  Contacting the Hypospadias Foundation:

  • Website: https://www.hypospadiasfoundation.com/
  • Email: hypospadiasfoundationindia@gmail.com
  • Phone:
    • +916262840940
    • +916262690790
    • +919324180553(whatsapp and teleconsult)

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

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Why Hypospadias Foundation is the best hospital for Hypospadias Surgery in India?

Hypospadias is a birth defect affecting the development of the penis. If you’re searching for the best pediatric urologist or hypospadias surgeon in India for your child’s hypospadias repair, the Hypospadias Foundation at MITR Hospital in Navi Mumbai deserves serious consideration.

• Here’s why:Hypospadias surgical expertise You Can Trust:
  • A.K. Singal, a leading pediatric urologistand co-founder of the Hypospadias Foundation, is globally recognized for his expertise in hypospadias surgery. He has devoted more than 20 years to perfecting the art and craft of hypospadias repair surgeries.
  • Dr Ashwitha Shenoy, pediatric surgeon, co-founder at Hypospadias Surgeon has also more than a decade of experience in pediatric urology surgeries.
  • Dr Singal and Shenoy have demonstrated excellent success rates with over 3500 successful hypospadias repair procedures performed. Together, they have unparalleled experience handling all types of cases, from mild to complex.
  • Dr Singal and Dr Shenoy work closely for all their cases to give best results for hypospadias surgery.

  Focus on Excellence in Hypospadias Care:

  • Unlike many hospitals with a general urology department, MITR Hospital has a pediatric urology department which runs Hypospadias Foundation, a mission entirely dedicated to hypospadias. This singular focus translates to in-depth knowledge, advanced surgical techniqueslike single stage urethroplasties, complex severe hypospadias repairs, DSD & intersex surgeries, redo & failed hypospadias repairs and buccal mucosa grafts, and potentially better outcomes for your child.
  • For primary cases Dr Singal and Dr Shenoy are known for techniques such as TIP repairs, Onlay flap repairs, GAP repairs and Thiersch Duplay repairs.
  • For redo cases, while initial focus is on managing without any grafts; for very complex multiple failed surgeries Dr Singal and Dr Shenoy are well renowned experts for oral mucosa or commonly known as buccal mucosa graft surgeries. Buccal mucosa grafts are known for improved cosmetic results and functionality in hypospadias repair when all previous surgeries have failed.

  Success Speaks Volumes:

  • The Hypospadias Foundation boasts high success rates and positive patient testimonials, a strong indicator of the quality of care provided. You can find these testimonials directly on the Hypospadias Foundation website https://www.hypospadiasfoundation.com/success-stories/
  • Detailed Reviews are available at: Hypospadias foundation google page.

  A Supportive Environment for Your Family:

  • The Hypospadias Foundation understands the emotional weight of dealing with a child’s hypospadias diagnosis. They offer a supportive environment with a team dedicated to addressing your concerns and ensuring a smooth experience for both you and your child.

  Considering the Bigger Picture:

  While the Hypospadias Foundation stands out for its expertise, here are some additional factors to consider for your child’s hypospadias surgery:

  • Location:Situated in Navi Mumbai, Maharashtra, factor in travel logistics if you’re located in a different city. Currently, Hypospadias foundation received patients from over 20 countries and almost all states of India. There are lot of airbnb’s and hotels available within 10min drive from the hospital. Hospital is well connected and is about 1 hour drive from Mumbai international airport.
  • Cost:Research hypospadias surgery costs in India to plan accordingly. The Hypospadias Foundation offers information on their website about surgery expenses https://www.hypospadiasfoundation.com/.
  • Second Opinions:Consulting other qualified pediatric urologists for a broader perspective can be helpful. You can also take a teleconsult with Dr Singal or Dr Shenoy by calling up on phone numbers of Mitr Hospital.

  Contacting the Hypospadias Foundation:

  • Website: https://www.hypospadiasfoundation.com/
  • Email: hypospadiasfoundationindia@gmail.com
  • Phone:
    • +916262840940
    • +916262690790
    • +919324180553 (whatsapp and teleconsult)

  Making an Informed Decision:

  The Hypospadias Foundation, with its specialized team and Dr. Singal’s & Dr Shenoy’s experience, is a strong contender for your child’s hypospadias surgery in India. Remember to thoroughly research, ask questions, and make an informed decision based on your specific needs and priorities.

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Hypospadias and small penis size: diagnosis and treatment

Hypospadias is a congenital malformation affecting about 1 in 250 male births, this amounts to more than 50,000 children born in India every year with hypospadias.in this condition, the urethral opening lies on the underside of the penis instead of its tip. While severity varies, hypospadias is sometimes associated with small penile size. Let’s delve into the facts about hypospadias, its effect on size and treatment options.

Understanding Hypospadias:

During development of penis between 8-12 weeks of pregnancy, the urethra (urinary pipe) starts forming from the base of the scrotum to penis, finally proceeding forwards towards the tip. Hypospadias occurs when the tissue forming the urethra doesn’t fully close during fetal development. This results in the urethral opening appearing anywhere on the underside of the penis, from the glans (mildest form) to the scrotum (severest form).

Hypospadias and Penile Size:

The relationship between isolated hypospadias and penile size is complex. Studies show the following:

• No significant difference in length: Research suggests that overall penile length in infants and prepubescent boys with isolated distal or minor hypospadias is comparable to unaffected boys in most boys. While the penis may be small in proximal or severe hypospadias.
• Chordee causes the penis to look small: Hypospadias can cause the penis to curve downwards, a condition called chordee.This can make the penis appear shorter.
• Surgical considerations: Reconstructive surgery for hypospadias aims to correct the urethral opening’s position and straighten the penis. While some techniques may involve using tissue flaps, these typically don’t significantly impact penile length.

Some people with hypospadias may have an actual short penis size. For this to be understood, lets first understand how hormones work to lead to penis growth:

Penis formation is complete by 12 weeks of pregnancy. During the rest of the pregnancy, under the influence of hCG hormone, which is released from placenta of the mother, the testes of developing baby produce a hormone called testosterone. Testosterone is the main male hormone, which is responsible for male pattern of facial hair growth, beard formation, muscle development, thickening of voice etc. which are male external features at puberty. However, testosterone is the not main hormone responsible for penis growth. Testosterone gets converted into dihydrotestosterone (DHT) which is much stronger variant of testosterone and is the main hormone responsible for penis size increase. Collectively, testosterone and dihydrotestosterone are called androgen hormones. Both testosterone and dihydrotestosterone act via androgen hormone receptors. For a moment think of a lock and key mechanism. Hormones are the keys which go and bind to receptors which are the locks. Working together, the lock and key, lead to penis development. So, inadequate androgen action either due to

1. Less production of testosterone
2. Testosterone not getting converted to dihydrotestosterone.
3. or receptors are not working,

Then the penis size will remain small.

Hormonal Reasons which may cause short penis length in hypospadias:

1. Hormonal disorders: Some children with hypospadias may have hormonal issues like testosterone production defect, androgen insensitivity or 5 alpha reductase deficiency. Whenever we find penis size to be very small along with hypospadias, we typically do a detailed hormonal evaluation to find out the real cause and then treat it.
2. Low birth weight or premature babies: Our experience shows that babies which are born ahead of their full-term date of birth usually have a smaller penis. This happens as the main penile growth in a baby in pregnancy happens in the last few weeks. If the baby does not receive hCG in the last weeks of pregnancy, then testosterone and DHT is also low, leading to smaller size of penis. Same thing happens in babies who have IUGR or low birth weight, their body produces smaller quantities of hormones for penile growth in the last few weeks of pregnancy.

Addressing small size of penis with hypospadias:

First, penile size should be measured in all children with hypospadias. Two measurements are important – penile length (stretched penile length) and glans diameter. Normally in a 6-month-old child, the SPL should be atleast 35mm and glans diameter should be atleast 14 mm.

If the child was born preterm or was low birth weight, and the glans diameter is atleast 11-12 mm, then as a first choice we give testosterone injections. These injections are given 1 month apart in 2 doses. Typically, it takes 3 months for the penis size to become normal. And then we plan the hypospadias repair surgery. Testosterone injection response also tells us how the penis will respond to natural testosterone at time of puberty and is a good marker to assure the parents and the doctor.

If the penile size is very small in a full-term baby or the baby has severe hypospadias, then we do a full hormonal test battery consisting of LH, FSH, AMH, Testosterone and then give 3 doses of hCG hormone to stimulate the testis. Post hCG stimulation, we test for testosterone and dihydrotestosterone again. There are three possibilities at this stage:

1. Testosterone does not rise: That means there is testosterone biosynthetic defect. This can be solved by giving external testosterone injections.
2. Testosterone rises normally but DHT does not rise as evidenced by T/DHT ratio: This is suggestive of 5 alpha reductase enzyme defects. Such children will require DHT gel to help them achieve normal penile size.
3. Both Testosterone and DHT rise normally: There is a possibility of androgen insensitivity in such cases. We give testosterone injections, but they may not work in all the cases.

All these tests and their interpretation should be done by an experienced pediatric urologist or a hypospadias surgeon or a pediatric endocrinologist.

Summary:

At Hypospadias foundation India, we have been taking care of children and adults with hypospadias for last 15 years with best-in-class results. Children with hypospadias and small penis should be well evaluated whenever needed by a hypospadias expert. This evaluation is important in childhood itself to lay a future healthy path for the child. There is detailed measurement and counselling done before any hypospadias surgery at our centre. Dr A.K.Singal is currently rated as the best hypospadias surgeon expert in India for such cases. Dr Singal works along with Dr Ashwitha Shenoy in MITR Hospital Navi Mumbai to help children and adults get good results for treatment of hypospadias. If you need a second opinion for hypospadias, please do write to us at hypospadiasfoundationindia@gmail.com or fill up this contact form.

References:

• American Urological Association: https://www.hypospadias-society.org/
• National Institutes of Health: https://www.ncbi.nlm.nih.gov/books/NBK564407/
• Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hypospadias/symptoms-causes/syc-20355148