Cases worth noting Archives - Hypospadias Foundation

January 01 2024

Does Hypospadias cause male infertility?

For some men with hypospadias, a congenital condition where the urethral opening lies somewhere on the underside of the penis, questions about fertility can loom large. While hypospadias itself doesn't directly impact sperm production, its associated complications can sometimes pose challenges. But remember, this doesn't mean that all men with hypospadias will necessarily be infertile. Let's delve into the link between hypospadias and fertility, exploring potential concerns, available solutions, and fostering hope for
fatherhood.

Understanding Hypospadias:

During fetal development, normally the urethra forms by folding of tissues from scrotum to the base of penis to the tip of penis. The failure of this urethral closure leads to hypospadias. The severity of hypospadias varies, with the opening appearing anywhere from the scrotum (scrotal hypospadias) to base of penis (penoscrotal hypospadias) to near the tip of penis (distal hypospadias). Besides the misplaced opening, most of men with hypospadias also have a downward bending of penis during erection- called chordee. 5% of hypospadias may also have associated undescended or an absent testis which can lead to lower sperm production. Such men need to be investigated for a disorder of sex development (DSD) or intersex.

Hypospadias and Fertility: the Possible Connections:

In isolated hypospadias with both normal testes, the sperm production usually remains unaffected, yet certain hypospadias-related factors can influence fertility:
 Urethral location: In severe unrepaired hypospadias cases such as scrotal or perineal or penoscrotal hypospadias, ejaculation might not be able to reach the vaginal introitus, hindering fertilization.
 Penile curvature: Significant curvature can make intercourse physically difficult. Sometimes erection can also be painful when there is significant chordee
 Meatal stenosis: abnormal hypospadias opening may be very small leading to urinary and sperm flow obstruction.
 Prostatic utricular diverticulum: Some men with severe hypospadias may also have a large sac near their prostate gland where sperm tubes (vas deferens) open. In such cases sperms may not flow out easily for fertilisation.
 Post hypospadias surgery issues: At Hypospadias foundation, we see lot of men who have had repairs done earlier and have poor fertility though they have a normal sperm production. The common reasons for this are complications of hypospadias surgery such as: residual curvature or chordee, stricture in new passage, diverticulum or baggy new urethra or fistulae in the urethra.

 Psychological considerations: Emotional concerns about body image or sexual function can sometimes affect intimacy and overall fertility.

Hypospadias Treatment Options: Paving the Way for having children

Fortunately, advancements in hypospadias surgery and infertility treatment offer effective solutions for addressing hypospadias-related fertility concerns:
 Hypospadias repair surgery: This procedure reconstructs the urethra and corrects penile curvature, often restoring normal ejaculation and improving sexual function. If there are complications from previous hypospadias surgeries such as stricture, residual chordee, fistula or a diverticulum- these can be repaired by an expert hypospadias surgeon leading to cure for infertility.
 Assisted reproductive technologies (ART): In cases where natural conception proves challenging, sperm retrieval techniques like testicular biopsy or micro epididymal sperm aspiration (MESA) can be combined with IUI, IVF, or ICSI to achieve pregnancy.

Maintaining Hope: Fatherhood is Within Reach for people with Hypospadias:

Do consult an expert and best hypospadias surgeon first. The hypospadias surgeon will check and confirm that the hypospadias repair is proper and there is no structural issue in repair. If there is some residual issue in hypospadias surgery, then that needs to be corrected first. If the infertility persists, then you must visit an andrologist for assisted reproductive techniques.

It’s crucial to remember:
 The majority of men with hypospadias have normal fertility.
 Early surgical intervention significantly improves the chances of successful fatherhood.
 Advanced treatments like ART offer alternative paths to parenthood. Open communication with your hypospadias doctor is key to understanding your unique
situation and exploring suitable fertility options. Remember, hypospadias does not define your potential as a father. With proper support and available treatments, you can navigate this journey and realize your dreams of having babies and building a family. At Hypospadias foundation, we treat hundreds of children and adults with hypospadias every year. Since 2008, Dr A.K.Singal, rated as the best pediatric urologist and hypospadias surgeon in India and the world, has devoted his life to helping people with hypospadias get best results and normal life. Along with Dr Ashwitha Shenoy, pediatric surgeon and hypospadias surgeon and a partner at Hypospadias foundation, the team at Hypospadias foundation, has deep expertise in diagnosing and treating complex hypospadias.

References:

 American Urological
Association: https://university.auanet.org/core/pediatric/hypospadias/index.cfm
 National Institutes of Health: https://www.ncbi.nlm.nih.gov/books/NBK482122/
 Mayo Clinic: https://www.mayoclinic.org/diseases-
conditions/hypospadias/diagnosis-treatment/drc-20355153

If you wish to have a teleconsult or a second opinion from Dr Singal/ Dr Shenoy, please write to us hypospadiasfoundationindia@gmail.com or fill up this contact form: https://www.hypospadiasfoundation.com/contact/

April 04 2021

Single Stage Repair Surgery for Distal Hypospadias and Penile Torsion

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

10-month child was brought with complaints of deviation of urine stream and abnormal location of meatus. On clinical examination there was distal penile hypospadias with severe penile torsion measuring 90 degrees to the left. We planned a single stage correction for both Penile torsion and distal penile hypospadias.

Penile torsion

Notice Penile torsion to left

Distal Hypospadias with Penile torsion

Surgery Steps:

Marking of the degloving incision. Local anaesthesia was infiltrated at the marked incision site. Complete degloving was done and chordee was assessed using artificial erection test. 30-degree chordee was noted. Chordee correction was done by Tunica albuginea plication at 12’O clock on the dorsal side. Following this correction, chordee was reassessed and no chordee was noted. Urethroplasty was started by incising urethral plate in the midline. Urethroplasty was done over a 7Fr Infant feeding tube with 6-0 PDS continuous sutures. Dartos flap was harvested for extra coverage over urethroplasty which was sutured using 6-0 PDS. Penoscrotal web correction was also done. Excess skin excised and sutured using 5-0 vicryl rapide. Skin flaps were rotated and adjusted to correct the penile torsion and sutured all around using 5-0 vicryl rapide. Dressing and catheter were in situ for 7 days. Following 7 days, dressing and catheter was removed.

Penile torsion and Hypospadias repair

Finished Hypospadias and Penile torsion surgery

Final outcome of correction of penile torsion and hypospadias

Results

The Final result was very gratifying with a straight penis without any torsion. The child was passing urine in good stream in straight axis without any discomfort or pain.

About Hypospadias repair and penile torsion

Penile torsion is a condition wherein the penis is rotated or twisted on its axis. The penile torsion is more commonly to the left. Many a time penile torsion may not be detected till a circumcision is planned or foreskin is retracted.

Penile torsion may be associated with hypospadias and/or chordee (penile curvature). With hypospadias, penile torsion is mostly associated with distal penile cases.

Based on the degree of glanular rotation, penile torsion can be classified as mild, moderate, and severe. It is mild if its less than 45 degree, moderate if it’s between 45-90 degree and severe if more than 90 degree.

Penile torsion in majority of cases (>85%) is between 10 to 20 degree. If it is a moderate or severe degree of torsion, urine stream may be deviated to one side.

Surgical intervention is not always required in isolated penile torsion. The indications for surgical correction are cosmetic, functional, or sexual. When penile torsion is associated with hypospadias, it should be corrected along with Hypospadias repair or urethroplasty at the same time.

About Hypospadias Foundation

Hypospadias foundation is a centre which provides personalized and best quality care for children and adults with hypospadias. It is one of the best hospital centres in India and world for surgical treatment for hypospadias in adults and children. Our dedication in the field of hypospadias has helped us achieve excellent outcomes in these patients. We treat children and adults not only from various parts of India but also from more than 25 countries all over the world. Hypospadias foundation is located at MITR hospital in Kharghar, Navi-Mumbai, Maharashtra, India. Every year more than 200 surgeries for hypospadias are performed at MITR hospital and Hypospadias Foundation

Contact us:

For appointment kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India
MITR Clinic: C1/8 Ground floor, Sector-2, VashiCall

Call for appointments: +91-2227743558/ 27744229/ 39/69 and +919324180553.

Or you can fill up this form- Contact form for Dr Singal

January 01 2020

Dr A.K.Singal presents his work at Hypospadias World Congress at Childrens Hospital of Philadelphia, USA

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Dr A.K.Singal was an invited speaker at Hypospadias World Congress at Children’s Research Center at Children’s Hospital of Philadelphia, USA, held between 30^th October 2019-1^st Nov 2019. Dr Singal presented four papers on hypospadias treatment and moderated scientific sessions during the conference.

The conference saw participation from more than 150 pediatric urologists and hypospadias specialists from across the world. The conference solely focussed on hypospadias. Various aspects of hypospadias were discussed such as etiology, diagnosis, hormonal tests and supplementation (testosterone injections), surgery techniques and complications/ results of hypospadias surgeries.

Dr A.K.Singal

Dr Singal with Dr Long & Dr Zaontz

Dr Singal presented the following lectures and papers in the World Congress:

Buccal inlay graft for failed hypospadias- Dr Singal showed technique of buccal (oral) mucosa graft inlay surgery and its results in failed hypospadias cases.
Considerations in adult hypospadias repairs- Adult hypospadias are difficult to manage especially if the surgery done in childhood has failed. Dr Singal showed innovative surgery techniques for such adult hypospadias cases for best outcomes.
Reimagined Byar’s flaps for staged hypospadias repairs- For hypospadias with severe chordee, it is important that the penile curvature gets fully corrected in first stage and then second stage surgery is done for bringing the urethra to the tip of penis. In expert hands the results of two stage surgery for hypospadias with severe chordee is very good. Dr Singal showed finer nuances of surgery to achieve best results to the audience.
Parental Awareness survey for families with hypospadias: Families of children or adults with hypospadias are often not fully aware of the extent of disease and what it means in the long run. Dr Singal and his team conducted a study of 150 families to understand about their concerns about hypospadias and their knowledge level about the disease/ surgery.

Overall the three-day conference resulted in great mutual exchange of ideas and also helped younger generation of surgeons learn from eminent faculty from all over the world.

June 06 2015

Letter from Australia makes our day and life worthwhile: Infant with scrotal hypospadias gets operated successfully in one stage in India

Hypospadias is a common urological anomaly and fortunately most of the hypospadias are distal or midpenile in variety with good results in one stage surgery. Scrotal hypospadias are the most severe forms of hypospadias where the opening in far behind in scrotum, in between the testicles. 6 months back we treated a child with hypospadias who travelled with his family all the way from Australia for a hypospadias repair surgery. But the story actually started as soon as the baby was born. The family had contacted us for an email and telephonic consultation and we were there with them from the neonatal age till the surgery and the care continues electronically even now.

Fortunately, with meticulous pre-surgery planning and good support we could get a good result of the surgery in one stage itself. The child is doing very well now and doesn’t look like that he will need any further hypospadias surgery. The family was overjoyed and they have sent us an email now (6 months after surgery) and we were all very happy to read the email. It made our day and also made the whole purpose of starting Hypospadias Foundation worthwhile.

We have taken the liberty of using most of the email in an unedited format here after seeking due permission from the family.

Hi Dr. Arbinder Singal,

How are you?

Please find below what we truly felt. Also as discussed, we would not prefer either our or or son’s name to be reflected in the recommendation, however please feel free to provide my details to parents who are in a similar situation and need help just like we did when our son was diagnosed with severe hypospadias.

First News

It all started on 2^nd December when my son was born in Sydney (Australia), it was the happiest moment of my life but I didn’t know that it will last only for the next 24 hours.

The next morning, as a usual process in Australian Hospitals, Specialists came to check my son and called me. The specialist checked my son and without any emotions or sympathy or even empathy told me that my son is suffering from Hypospadias and that too a severe one and it will take at least 2-3 operations period. My ears were striving hard to hear that after those operations it will be completely cured and everything will be fine but the doctor told me that the Hypospadias is severe and there is no guarantee and gave me an information booklet with scary after operation images. As far as I remember I asked him thrice may be more that whether my son would be alright after those operations? yearning for an answer that “everything will be alright” may be a pat on my shoulder to give me some strength or courage to deal with the situation but he left without saying even a single positive word.

I could barely walk after that conversation, everything around was meaningless and sad. My wife was still in the hospital recovering from the caesarean operation, I chose not to tell anyone in my family and let them be happy. I came home that night as you are not allowed to stay in the hospital in Australia. I was not able to sleep that night and the next morning while I was still at home, all my emotions came out, I couldn’t stop the tears and my family came to know about it and tried to give suggestions but that doctor had filled my whole system with so much negativity that I believed that there is no solution and my son will never be cured. After venting out my emotions, I started researching about Hypospadias specialists in the world and I found Dr V.R.Jayanthi and called his clinic in U.S.A but he was not available. I did some more research and found Hypospadias foundation in Navi Mumbai, India. Honestly I didn’t care to read the content on the site and went directly to the contact us page as I was so desperate to talk to a specialist and got through Dr. A.K. Singal’s clinic and fortunately they helped me to set up an telephonic appointment with him.

Half an hour Conversation changed everything!

Carrying a huge backlog of negativity, I called up Dr. Arbinder Singal. The conversation started with a lot of questions and Dr. Arbinder Singal listened to all my questions and concerns patiently and irrespective how silly the questions were, he answered to every question in detail. Honestly that conversation changed my life and in particularly one sentence from him – “THERE IS NO HYPOSPADIAS WHICH CANNOT BE CURED”. He guided me to contact a pediatric endocrinologist right away and explained in detail on how to proceed with the next steps. I recorded that conversation and told my wife about the news because now I had the solution – Dr. Arbinder Singal!

A Close shave

I am really thankful to Dr. Arbinder Singal for recommending a pediatric endocrinologist at that point. I want to again emphasize here that everyone apart from Dr. Arbinder Singal missed an important step in the journey – Meeting a Pediatric Endocrinologist.

As per the paediatric endocrinologist – Dr. Andrew Biggin (he is still my son’s paediatrician and has agreed to mention his name) there were some injections which needed to be given to my son before a certain age which we would have definitely missed as no other Doctor asked us to meet a paediatric endocrinologist. We communicated a lot with Dr. Arbinder Singal updating him about the progress and again asking questions to which he patiently responded every time. He also helped us to get in touch with the other parents whose children had undergone hypospadias repair surgery under his care which helped a lot as they explained us how they went through the treatment and journey. We are really thankful to those parents as well as every time we had an emotional breakdown or we felt nervous they acted as a big emotional support and had long conversations calming us down. Finally Dr. Arbinder Singal helped us decide a date and hospital for hypospadias operation.

The Surgery..

We travelled to India for surgery and we arranged a villa near Fortis Hospital in Vashi, Navi Mumbai and went to meet Dr. Arbinder Singal for the first time in Mumbai. After our meeting the comfort level and confidence increased multi-fold, he was very nice to speak with and inculcated the same confidence in us. He checked my son and said he will try to do it in one operation itself. We had already booked a room in Fortis and admitted my son for the surgery. We met him again before the hypospadias operation, we were nervous but we were calm as we knew that our son was in safe hands. All the hospital staff was very helpful on the operation day and Dr. Arbinder Singal gave us the good news that the operation is successful and my son would not need another surgery.

Highly Highly Recommended!

I would highly recommend Dr. Arbinder Singal as he is an hypospadias expert and good human being. He is reachable and understands the emotions & nervousness which the parents go through. All the more the issue which all the doctors in Australia could solve only by doing multiple hypospadias surgeries, he did that in one go with a single stage hypospadias repair.

I and my family are and would be really thankful to him for forever.

Thanks Dr. Arbinder Singal & Hypospadias Foundation!!

Regards,

A happy kid and his family

Sydney, Australia

About Hypospadias Foundation and Dr A.K.Singal

Hypospadias Foundation is an organisation dedicated to care & cure for patients children and adults suffering from Hypospadias and DSD (disorders of sex development). It is located within a boutique Urology centre – MITR Hospital in Kharghar, Navi Mumbai, India (www.mitrhospital.com ). Hypospadias Foundation was started in 2009 by Dr A.K.Singal and Dr Manish Dubey and till date more than 800 children and adults have been treated at the Foundation from all over India and more than 20 countries (june 2015). The foundation keeps on growing with blessings from families and support from society.

Dr A.K.Singal is a renowned pediatric urologist surgeon and a top hypospadias specialist practicing in Mumbai, India. He is an expert in management of children and adults with hypospadias and is a strong force behind community and medical education for hypospadias. Every year he does more than 200 surgeries for hypospadias and conducts research for hypospadias. For his deep passion and excellent results in hypospadias, Dr Singal is counted as one of the best hypospadias surgeon’s in the world.

Hypospadias Foundation can be reached at hypospadiasfoundationindia@gmail.com or you can call Dr Rajkumar (Coordinator) at +919821261448

Or you can fill up this contact form: Contact Hypospadias Foundation

Watch Video of Scrotal Hypospadias Surgery by Dr A.K.Singal