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May 05 2025

Outcomes for adult hypospadias surgery: What surgery can and cannot achieve for you!!

Author Dr. A.K.Singal Categories About Hypospadias

Adult hypospadias surgery is fundamentally different from operating on a child. When we started hypospadias foundation in 2008, we started with an aim to help children with hypospadias and DSD get better outcomes. In 2015 we started getting lot of enquiries from adults with hypospadias. We realised that neither adult urologist or pediatric surgeons or plastic surgeons are equipped to deal with a congenital anomaly like hypospadias in adults. Whether it a primary non-operated hypospadias in an adult or a failed hypospadias repair in an adult, it is very different from the children. Hence, it is very important for the hypospadias surgeon to set the right expectation during the counselling session before hypospadias repair surgery. Unless the expectations are matched, no one is going to be happy after surgery.

Dr A.K.Singal and Dr Ashwitha Shenoy operating on a patient with hypospadias

What can adult hypospadias surgery accomplish:

1.Straight penis by chordee correction: If the person has a hypospadias with a bent penis, it can be fully corrected, and a straight penis can be achieved. We use a variety of chordee correction techniques like 16 dot plication Chordee correction surgery in an adult redo hypospadias using 16 dot plication in adults to achieve good outcomes.

2.Achieve urine opening at the tip: In almost all primary hypospadias, we are able to achieve an urinary opening on the tip of penis. In failed hypospadias or ones with previous surgeries (unless the glans -the head of penis- is damaged), with modern techniques, we are able to achieve opening on the tip. Rarely, if there is fibrosis or deformed glans due to previous surgery- we try to bring the opening as close to the head as possible.

3.Good Cosmetic result: In most of adult hypospadias, we are able to achieve a good cosmetic result with a straight penis, opening on the tip and a circumcised appearance. With modern stitches, good instruments and trained expert hypospadias surgeons, the stitch marks are also very less. Single stage hypospadias repair in an adult

4.Ease in intercourse: Some of the adults come to us with difficulty in intercourse due to chordee. Once chordee is corrected, the intercourse becomes painless and easy.

5.Standing up and passing urine: One of the chief complaints in hypospadias is that the urine goes backwards. Hence, the male has to sit to pass urine. This is especially true for proximal penile, penoscrotal or scrotal hypospadias. Once hypospadias is corrected, the urine goes forwards and the person can stand up and pass urine like a normal man. (urine stream pic)

6.Straight stream without spraying: Most of unoperated or failed hypospadias repair come to us with spraying of urine. This happens when the urine hole is not on the head, the urine doesn’t get a proper direction to form a nice stream. Once the hypospadias is corrected, urine starts coming in a normal single stream from the head of the penis and directed forwards without spraying.

7.Passage of urine from one hole: Some of the failed hypospadias cases may have multiple holes due to urethral fistulae. Due to these the person may be passing in 2, 3 or more streams. We have seen cases where the person was passing urine like a watering can due to multiple holes. This can all be corrected with successful adult hypospadias surgery by an expert surgeon.

8.Healthy mental state: We have seen lot of young adults, who feel inferior and incomplete due to a deformed penis because of hypospadias. They often are hesitant to establish relations with opposite gender. Once repaired with a good result, these men report higher mental self esteem and comfort in establishing healthy relationships. If the depression and anxiety is severe, it is a good idea to discuss with your surgeon and take some psychology help before and after surgery,

What adult hypospadias surgery cannot accomplish:

1.Increase in penis size: Hypospadias surgery leads to correction of anomaly but not an actual increase in size of penis. In some cases with severe chordee, unrepaired penis may look small due to chordee. Once we correct such cases, the penis may look longer due to straightening of the penis.

2.Solve premature ejaculation: Premature ejaculation is not related to the hypospadias and hence surgery can’t solve this. For such issues we refer the cases to adult urologist for treatment.

3.Erectile dysfunction: Some men with hypospadias come with erectile dysfunction, generally this is not related to hypospadias itself. It may be psychological or due to some other anomaly. Hypospadias by itself doesn’t cause erectile dysfunction and repairing hypospadias doesn’t improve it either. For such issues we refer the cases to adult urologist for treatment.

4.Cure infertility: Hypospadias may cause difficulty in intercourse if there is severe chordee but generally doesn’t cause infertility. Hence, if the sperm count is low or poor, doing a surgery will not solve this. For such issues we refer the cases to adult urologist for treatment.

It is important that adults with hypospadias discuss these issues threadbare with their treating hypospadias surgeon before surgery. We also take help of a clinical psychologist or an adult urologist whenever needed before surgery to set the right expectations. At Hypospadias Foundation India, we are dedicated to helping adults and children with hypospadias get the right diagnosis, full counselling, expectation setting and surgical treatment with empathy. With both the surgeon and the patient aligned, great outcomes and happiness can be achieved.

Dr A.K. Singal is rated as the best hypospadias surgeon in the world for adult hypospadias surgery. Dr Ashwitha Shenoy is a well-trained pediatric urologist and hypospadias surgeon working with Dr Singal. Together as a team both of them treat hundreds of adults and children with hypospadias from across India and the world every year with best care and results. With advancing experiences, the complications of adult hypospadias have decreased significantly, and success rates are above 96% at Hypospadias Foundation.

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    December 12 2024

    Navigating Uncertainty: Understanding the Risk of Hypospadias in a Second Child

    Author Dr. A.K.Singal Categories About Hypospadias

    The birth of a child brings immense joy, but also concerns about their health and well-being. For parents who have experienced the challenges of hypospadias in their firstborn, questions about the risk of recurrence in a second child understandably arise. This blog aims to provide insights and guidance on this sensitive topic.

    What is Hypospadias and is it necessary to repair it?

    Hypospadias is a birth defect affecting boys, characterized by an abnormally positioned urethral opening. This opening, which normally lies at the tip of the penis, can be located anywhere along the shaft, scrotum, or even perineum. While the severity varies, hypospadias can affect urination, sexual function, and self-esteem. For very minor hypospadias without any chordee, family may choose to not do surgery but after consultation with an expert hypospadias surgeon. For all other hypospadias, correction surgery is recommended.

    Is My Second Child at Risk of Hypospadias?

    The possibility of hypospadias occurring in a second child depends on several factors:

    • Family history: If the father or a brother has hypospadias, the risk in subsequent sons increases. Estimates suggest 5-6% risk for a second son and this risk increases further if both father and brother are affected.
    • Environmental factors: Exposure to certain environmental toxins, such as pesticides and herbicides, may play a role. These pesticides are known to be endocrine disruptors, they interfere with the androgen and oestrogen signalling pathways during genital development, hence causing hypospadias. This is a hypothesis, and studies are still under process to clearly link exposure of pesticides to occurrence of hypospadias. There have been studies showing higher risk of hypospadias due to plasticisers in the single use plastic bottles. The chemicals here act as male hormone blockers and interrupt development of penis, hence causing hypospadias.
    • Hormonal exposure in pregnancy: During pregnancy, certain hormones may be advised for the mother to decrease the chance of preterm labour or miscarriage. This is common after invitro fertilization (IVF) conception, twin pregnancy and in precious pregnancies. Carmichael in his study reported that the use of progesterone to prevent early pregnancy loss was associated with risk of developing moderate to severe hypospadias1.
    • Maternal health: Maternal smoking, pre pregnancy obesity, folic acid deficiency is some of the associated factors causing hypospadias.

    Understanding the Probabilities of second child with hypospadias

    While the above factors influence the risk, it’s important to understand that they do not guarantee the condition’s recurrence. Each pregnancy is unique, and predicting with certainty is impossible.

    Here’s a breakdown of the estimated risks:

    • For a family with no history of hypospadias, the general risk is around 1 in 250 births
    • If the father has hypospadias, the risk rises to about 1 in 50
    • With a brother affected, the risk increases to approximately 1 in 30
    • When both father and brother are affected, the risk becomes roughly 1 in 20

    Moving Forward: Taking Charge

    Despite the uncertainty, proactive measures can empower parents to understand hypospadias and get proper counselling to understand the possibility of hypospadias in their second child. This includes:

    • Genetic counselling: Consulting a genetic counsellor can provide personalized risk assessment and guidance based on your specific family history. Genetic analysis can help us know the possibility of hypospadias in subsequent pregnancies.
    • Preconception care: Maintaining good health and avoiding harmful substances during pregnancy can minimize potential environmental influences. Folic acid supplementation should be started before conception and continued during the first trimester to avoid hypospadias.
    • Prenatal testing: While currently no specific tests diagnose hypospadias in utero, advanced ultrasound technology may detect anatomical abnormalities suggestive of the condition. This is possible only in countries where predetermination of sex of the child is allowed in ultrasound in pregnancy.
    • Early diagnosis and intervention: If hypospadias is diagnosed after birth, early intervention through specialized treatment can optimize outcomes. Early referral to an expert hypospadias surgeon, early surgery can help the parents and child to overcome the hypospadias problem.

    Remember that Knowledge is power. By understanding the risk factors and available resources, parents can navigate the uncertainty surrounding hypospadias and make informed decisions about their second pregnancy.

    Let’s work together to raise awareness and offer support to families affected by hypospadias.

    Additional Resources:

    1. Carmichael SL, Shaw GM, Laurent C, Croughan MS, Olney RS, Lammer EJ. Maternal Progestin Intake and Risk of Hypospadias. Arch Pediatr Adolesc Med.2005;159(10):957–962. doi:10.1001/archpedi.159.10.957
    2. Urology Care Foundation: https://www.urologyhealth.org/educational-resources/hypospadias
    3. National Institute of Child Health & Human Development: https://pubmed.ncbi.nlm.nih.gov/35398463/
    4. Hypospadias Association: https://heainfo.org/

    About Hypospadias Foundation

    Hypospadias Foundation is a centre specialized for treatment of children with hypospadias. Our expertise in hypospadias makes us one of the best centres for hypospadias repair in the world. We treat children from more than 25 countries in the world and from all over India. Our dedication in this field has helped us achieve excellent outcomes. Hypospadias foundation is located at MITR Hospital in Kharghar, Navi Mumbai in the state of Maharashtra.

    Dr A K Singal is an expert and top hypospadias surgeon in India. He is a gifted surgeon and his expertise in this area has helped us achieve excellent outcomes in primary and failed hypospadias in children as well as adults.

    Dr Ashwitha Shenoy is an expert hypospadias surgeon with special interest in hypospadias and pediatric urology. Both Dr Singal and Dr Shenoy work together to give best results for hypospadias surgery in India for both children and adults.

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      June 06 2024

      Safe and Effective Anesthesia for Hypospadias Repair Surgery in Children

      Author Dr. A.K.Singal Categories About Hypospadias

      Hypospadias surgery is a procedure to correct the opening of the urethra on the underside of the penis. It is one of the most common pediatric urological surgeries. Ensuring your child’s safety and comfort throughout the surgery is paramount. Anesthesia plays a crucial role in achieving this goal.

      Types of Anesthesia for Hypospadias Surgery:

       General Anesthesia: The most common approach, general anesthesia renders your child unconscious and pain-free. Medications are typically
      administered intravenously (through an IV) or via inhalation through a breathing mask. The anaesthesia is usually short and there is no significant
      effect on the child.

       Regional Anesthesia: Regional anaesthesia is one which works only in the specific area of the body. The regional anaesthesia used in hypospadias
      repair is a caudal block, an injection near the tailbone for targeted pain control. This caudal block gives good pain relief for six to eight hours and
      sometimes even up to ten hours after hypospadias surgery. Older children may feel tingly and numb in the lower limbs and may find it difficult to walk till it wears off, usually within first 12 hours

       Combined Anesthesia: Combining general and regional anesthesia offers the benefits of both: comprehensive pain management during surgery and a smoother recovery from general anesthesia.

      The anaesthesia medicines chosen in children is such that there are minimal side effects and, we can resume oral intake as early as 1-2 hours after the hypospadias correction surgery.

      Pediatric Anesthesiologists:

      Anesthesia for hypospadias surgery is administered by a trained pediatric anesthesiologist, a medical doctor specializing in anaesthesia for infants and children and takes good care before, during, and after hypospadias repair surgery. They will meticulously assess your child’s health before hypospadias surgery, discuss anesthesia options, and choose the safest and most suitable approach for your child’s individual needs.

      Communicate and Ask Questions:

      Open communication with your child’s hypospadias surgeon & urologist and anesthesiologist is vital. Don’t hesitate to ask questions regarding the anesthesia plan and any concerns you may have. Feeling informed and involved in your child’s care can significantly ease anxieties.

      At Hypospadias foundation, we have trained pediatric anesthesiologists who have managed more than thousands hypospadias correction repairs. From airway management, right medications to post operative pain relief we believe in a complete care of the child from pre surgery to post surgery. Safe and effective anaesthesia is necessary for good post operative recovery after hypospadias surgery.

      Effective Pain Relief After Hypospadias Surgery

      Pain relief is very important especially in a child because a cranky child makes the parents and the hypospadias surgeon anxious. After any procedure, it’s natural for your child to experience some discomfort but the discomfort should be manageable. Here’s a guide to effective pain relief after hypospadias surgery:

      Doctor-Prescribed Medications:

       Pain relievers: After surgery we prescribe pain medications, often starting with acetaminophen(paracetamol) or ibuprofen. The medicines must be given as advised because good pain relief means a comfortable child and in turn leads to good healing after hypospadias repair.

       Antibiotics: To prevent infection, antibiotics are prescribed after hypospadias surgery. They must be continued till the catheter removal and
      sometimes for a few days even after the hypospadias catheter is removed. Infection can destroy the entire hypospadias repair hence we need to be
      vigilant and avoid infection at all costs.

       Bladder antispasmodics: The presence of a urinary tube can cause urinary bladder contractions. The only way to manage this is by prescribing anti spasmodic medicines. Hence after hypospadias surgery till the catheter removal, the child will be on anti-spasmodic medicines.

       Pain due to erection: Painful erections after hypospadias surgery occur in every child and are even more prominent in teenagers and adults. This pain can be quite bad due to swelling of penis and the presence of a urinary tube. Hence we prescribe a stronger painkiller diclofenac in the form of
      suppository during these episodes of severe pain. This medicine gives good pain relief in times of extreme pain. For adults we also add more medicine to decrease painful erections at night.

      At-Home Pain Management Strategies:

       Positioning: Encourage your child to rest comfortably, positioning themselves to minimize tension on the surgical area. This can be lateral or
      supine position with pillow support.

       Distraction: Engaging your child in their favourite activities or games can help take their mind off any discomfort after hypospadias surgery

       Loose Clothing: Tight clothing can apply pressure on the operated site and cause discomfort to the child. Opt for loose-fitting clothing made from
      breathable fabrics to avoid irritation.

       Dietary Adjustments: Prefer healthy nutritious food over processed food. Processed food does not have fibre and cause constipation in a child which in turn can cause bleeding at the operated site during straining. Maintaining hydration is also essential to prevent constipation.

       Hygiene: Maintain proper hygiene around the hypospadias surgical site as instructed by your doctor. Change inner diaper frequently when dirty and be vigilant for soling of dressing. If dressing gets dirty at any point, do visit the hospital and get a hypospadias dressing change.

       Activity Restrictions: Follow the doctor’s recommendations regarding activity levels to promote healing and prevent complications. Any vigorous
      activities are generally avoided typically for 4-6 weeks after hypospadias surgery. Children can play at home and other board games comfortably.

      Remember:

       Consult your Hypospadias Doctor: If pain seems excessive or worsens, consult your child’s doctor for further evaluation and possible medication
      adjustments.

       Be Patient: Healing takes time after a hypospadias surgery. Be patient with your child and offer support throughout the recovery process.

      At Hypospadias Foundation India, we have treated thousands of children and adults with hypospadias. Our approach to hypospadias repair includes
      comprehensive care from preoperative to post operative period. Remember, every child heals at their own pace. By being prepared, informed, and supportive, you can help your child through this journey and ensure a successful recovery. Dr A.K.Singal and Dr Ashwitha Shenoy are rated as the best hypospadias surgeons in India. Their experience in the field of hypospadias makes them the best surgeons for hypospadias repair for both children and adults. If you need an opinion or consult us for your child, please do write to us at hypospadiasfoundationindia@gmail.com or fill up this contact form or visit us at the hospital.

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        April 04 2024

        Recovery after hypospadias repair surgery

        Author Dr. A.K.Singal Categories 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.” Understanding the recovery process after hypospadias repair surgery is crucial for parents and caregivers. This comprehensive guide provides insights into postoperative care and tips for managing the recovery journey effectively.

        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.

        Recovery after hypospadias repair surgery
        • 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.
        Recovery after hypospadias repair surgery
        • Pic 2: Hypospadias surgery site inspection at week 1 after surgery
        Recovery after hypospadias repair 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:

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

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