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B.Q., a 7-month-old baby, was brought to our clinic with an abnormal-looking penis and passage of urine from the underside of the penis. On examination, he had a scrotal hypospadias with mild chordee (an abnormality where the penis is bent downwards).

A boy with scrotal hypospadias – Transverse Island Onlay Flap urethroplasty was planned for corrective surgery. This specific case involved a single-stage urethroplasty, for which many different techniques are available. The exact technique in this case was a long transverse island flap urethroplasty.

This is the appropriate age (6-9 months) for such surgeries as the final results are very good both cosmetically and functionally at such a young age. We chose to give two doses of hormones before surgery to improve the outcome after single-stage surgery.

Since this was a very severe hypospadias, the chances of failure were higher. We decided to harvest a tunica vaginalis flap for second-layer coverage of the repair (see pictures). The tunica vaginalis is a covering of the testis and provides good second-layer coverage in such severe cases, improving the outcomes manyfold.

The baby was taken up for surgery and required only a one-day stay in the hospital. The dressing was removed on day 5 and the catheter on day 12. There was no fistula or dehiscence.

At the 3-month follow-up, he had a normal-looking circumcised penis with a urethral opening at the top of the glans.

S.J., an 8-month-old baby, was brought to Dr. A.K. Singal’s Hypospadias clinic with an abnormal-looking penis and passage of urine from the underside of the penis, almost near the scrotum. On examination, he was diagnosed with a condition called Penoscrotal Hypospadias with mild chordee (an abnormality where the penis is bent downwards). The baby was planned for a corrective hypospadias surgery called SINGLE STAGE URETHROPLASTY, which can be done by multiple techniques, including the Transverse Island Onlay Flap urethroplasty. This technique is particularly suited for cases like a boy with severe hypospadias.

The exact technique in this case was a long Tranverse Island flap urethroplasty. This is the appropriate age (6-9 months) for such surgeries as the final results are very good both cosmetically and functionally at such a young age.

The baby was taken up for surgery and he required only one day stay in the hospital. The dressing was removed on day5 and the catheter on day12.

At 3 months follow-up he has a normal looking circumcised penis with a urethral opening at the top of the glans

Facts about Hypospadias

• Hypospadias is one of the most common pediatric urological anomalies worldwide.
• The correct age for hypospadias repair surgery is between 6-9 months.
• Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex development, a two or a three stage hypospdias repair may be required.
• The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
• Most common problems after hypospadias surgery procedure (5%) are infection and formation of a urethral hypospadias fistula requiring a second surgery.

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis (Coronal Hypospdias) and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hyoplastic urethra. These types of hypospadias may deceptively look mild as the thin distal urethra often needs to be excised and the hypospadias becomes a severe one. The child was planned for a single stage hypospadias repair by Dr A.K.Singal (Hypospadias Specialist)

During hypospadias surgery, hypoplastic urethra was excised and the penis was straightened (chordee reapir). A flap was made from the excess skin on the upper side of penis – this technique of Single Stage Urethroplasty is called Transverse Island Flap Urethroplasty. The flap was rotated towards the underside of penis for making a new urinary pipe. The baby was discharged the next day after surgical correction of hypospadias and double diaper was used for draining the catheter.

Dressing was removed five days after single stage urethroplasty and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis indicating a successful hypospadias surgery

Facts about Hypospadias

• Hypospadias is one of the most common anomalies worldwide.
• The correct age for corrective surgery is between 6-9 months.
• Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
• The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
• Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery.
• Link to Hypospadias foundation
• Link to FAQ’s about hypospadias

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis (Coronal Hypospdias) and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hyoplastic urethra. These types of hypospadias may deceptively look mild as the thin distal urethra often needs to be excised and the hypospadias becomes a severe one. The child, a boy with distal penile hypospadias, was planned for a single stage hypospadias repair by Dr A.K.Singal (Hypospadias Specialist).

During hypospadias surgery, hypoplastic urethra was excised and the penis was straightened (chordee reapir). Incision was given in the urethral plate in the midline and urethroplasty done which is called Tubularized Incised Plate Urethroplasty. The baby was discharged the next day after surgical correction of hypospadias and double diaper was used for draining the catheter.

Dressing was removed five days after single stage urethroplasty and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis indicating a successful hypospadias surgery.

Facts about Hypospadias

• Hypospadias is one of the most common anomalies worldwide.
• The correct age for corrective surgery is between 6-9 months.
• Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
• The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
• Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery.
• Link to Hypospadias foundation
• Link to FAQ’s about hypospadias