For Parents and Patients Archives - Hypospadias Foundation

May 05 2015

Cashless or Mediclaim Coverage of Hypospadias repair surgery and treatment by Insurance Companies in India

Hypospadias is a urinary birth defect in which the urinary opening is on the underside of penis rather than being at the tip of the penis. In more than 50% of patients with hypospadias, the penis is also bent downwards – this penis curvature is called chordee. Hypospadias affects 1/150 newborn boys and hence more than 1 lakh (1,00,000) kids are born in India with hypospadias every year. Worldwide the incidence has increased probably due to increasing burden of chemicals and pollutants which act as endocrine disruptors (chemicals which block male hormone action) and have contributed to an increasing incidence of hypospadias.

Most of these kids except the ones with very minor glanular hypospadias without chordee will need surgery. The surgery is ideally done between 6months-18 months for age of the child was born with good weight and full pregnancy, if the child is underweight or preterm or has any other major anomalies then it may be better to wait till the child is about 3 years of age.

When and how does hypospadias happen?

Hypospadias results from defective formation of urinary tube during 8-12 weeks of pregnancy and hence if there is an interference with penis development after 12 weeks of pregnancy, hypospadias cannot happen as penis formation with urinary opening at tip is complete by 12 weeks of pregnancy. Between 8-12 weeks of pregnancy, the urinary pipe forms under the penis from the base to the tip under influence of testosterone and dihydrotestosterone. Along with the urinary tube the various covering layers of the penis such as spongiosum , bucks, dartos and skin also also formed. Hence when the urethra remain short of tip, all surrounding layers also become short.

Is Hypospadias repair surgery covered by insurance companies or corporates for cashless treatment or re-imbursement?

Hypospadias being a penis birth defect is classified as an external birth defect which can be easily diagnosed as soon as the baby is born. Hence, if parents take an insurance policy after the baby is born, hypospadias surgery treatment costs are not covered by most of the insurance companies in India atleast while in USA, UK it is covered under insurance benefits.

The situation is different for some of the corporate insurance group policy holders. Some big corporates like TCS, Reliance, L & T, Siemens etc issue very employee friendly mediclaim policies which cover all medical and surgical treatments for the employees and their families. Such mediclaim policies cover all pre-existing as well as birth defects for their employees and hence hypospadias repair procedure may be covered by the insurance company by some of these companies.

If insurance does not cover the hypospadias treatment, how much does it cost for Hypspadias repair surgery?

If the insurance company is not covering the treatment, then the parents will have to pay the full charges themselves out of their own pocket. For new parents working in a job or middle class environment this may be financially stressful. What really helps is that Hypospadias repair surgery is a planned procedure. It can be done anytime between 6 months-15 months of age giving parents enough time to rally around and arrange everything from money to other resources. The cost of hypospadias repair surgery depends on the type of hypospadias, complexity of repair, which hospital as well as which type of room one chooses to stay in hospital. On a ball park figure it may wary from 75000 Indian rupees for a minor hypospadias surgery in Hypospadias Foundation to even 3,00,000 Rupees for a complex severe hypospadias surgery in a single deluxe room. Hence, it is best that they meet a hypospadias expert or a pediatric urologist early on in first 3 months of baby’s life and then learn everything about the cost of hypospadias surgery, hospital stay, pre-hypospadias surgery tests and then get mentally prepared for the actual surgery.

About Hypospadias Foundation, Navi Mumbai, India

Hypospadias Foundation is an organisation started by Dr A.K.Singal and Dr Manish Dubey for caring, education and research in field of Hypospadias. Dr Singal is one of the best Hypsoapdias Surgeons in India. The team operates more than 200 children and adults every year with best results in hypospadias treatment. The Foundation operates as a part and parcel of MITR Hospital in Kharghar area of Navi Mumbai. MITR Hospital has cashless and mediclaim tie-ups with all major insurance companies and TPA’s to facilitate cashless treatment of hypospadias if the insurance policy covers it.

If you or your child has hypospadias and need to know more, please write to us at hypospadiasfoundationindia@gmail.com or fill up this contact form

Contact form for Hypospadias Foundation

Watch Videos on Hypospadias Channel by Dr A.K.Singal

Video of Distal penile hypospadias repair surgery

Video of Proximal penile hypospadias surgery

Video of Scrotal hypospadias repair

August 08 2014

Preoperative instructions for children undergoing hypospadias repair surgery

Hypospadias is often diagnosed at birth or in the first few weeks when a pediatrician does a general examination. It may be a time of great anxiety for the parents when they learn that their child has a urological abnormality which may need surgery. The word surgery may be itself be scary and on top of that surgery on a child and that too on penis. That being said, results of hypospadias repair procedure are very good now, mostly with a smooth pre surgery and post surgery course.

Parents often wonder about what needs to be done before the hypospadias surgery in terms of preparation. Hence, we have tried to put some of this information in this blog which is more general in nature as the specific information can be only shared by the actual hypospadias expert surgeon managing the child.

Before the surgery, besides the usual tests for fitness to make sure that the blood parameters are fine, we always ask for thorough examination to make sure that the child is not having any other concurrent illness such as respiratory, skin or intestinal infection. If the examination and the tests are normal, then we sit with the family and fix up a date for surgery. If the date is far out, we call for another review one week before surgery to ascertain that everything is ready for surgery. Sometimes the parents and families are travelling to us from a long distance away from within India or other countries, then we try to conduct a phone call one week before the hypospadias repair. In our pediatric urologist services, we try to keep hypospadias operation as the first case every day. This ensures that the staff is in the best of their spirits and best of their energy.

Empty stomach: The child needs to be empty stomach for atleast 4 hours for breast milk and 6 hours for solid foods/ breads on the day of surgery before surgery. This is a mandatory safety precaution to prevent vomiting during anesthesia. Keeping a 6 months or a one year old child hungry for 4 hours is not an easy task. Infact some of the parents are more worried about keeping a young child hungry than the actual surgery but this is something which is non-negotiable. Often we give the child light sedative syrup 1-2 hours before surgery to help the baby sleep.
Bathing: We ask the parents to give the child a bath on the morning of hypospadias operation as it will be difficult to give a formal head to toe bath for next 5-7 days after..321 surgery.
Potty: Some of the children may be a little constipated, we advise parents to give a glycerine suppository or a laxative the night before so that the child has an empty bowel. Post hypospadias surgery, local pain often leads to a temporary constipation.
Admission: In a hospital with daycare facility, we admit the child for hypospadias operation at 6:30am -7am. If the parents live farther away from the hospital or the hospital doesn’t have a daycare facility, we like to admit the children the night before surgery. At Hypospadias foundation in Navi Mumbai, India we mostly admit the children in the morning of the surgery itself unless the parents live more than 50km away or do not have a means of traveling early in morning.
Clothes: Children are changed into hospital clothes appropriate for their age on the morning of surgery. Make sure that the iv canula is inserted after changing of clothes.
Sedation: If the child is irritable while staying hungry we either advise a pacifier or a light sedative syrup till the time of anesthesia.
Induction: Crying child is not a good sight just before hypospadias surgery for the parents or the hypospadias doctor. If the child has an iv line, anesthesia team often administers a small dose of premedication to help sedate the child before shifting to operation theatre.
Consent: Before hypospadias surgery is started, family has to fill up an anesthesia and a surgery consent form which is quite detailed in general. Sometimes the parents get alarmed on seeing the form. But please feel free to ask us about any doubts which you have. We always have the best of intentions and efforts to get your baby back home safely after hypospadias surgery.

We must understand that getting the child with hypospadias fully cured is a team effort and it needs devotion and patience from both the family as well the surgical team. We at Hypospadias Foundation are committed towards making the whole hypospadias treatment experience seamless, less bothersome, more baby friendly and easy for the families. This also translates into better results sheerly stemming from deep interest in wellbeing of babies with hypospadias.

Please contact us if you have any questions for us by submitting your query here. Dr Singal and his team will be more than happy to help.

Dr A.K.Singal is a renowned and one of the best Pediatric urologist’s in Indian subcontinent. He is known for excellent results and devotion to managing children and adults with hypospadias and Disorders of sex development. He runs his urology and hypospadias clinics in Navi Mumbai and Mumbai area of western India. Dr Singal is outspoken advocate of achieving best results for hypospadias both clinically and psychosocially.

Contact Form for Hypospadias Foundation

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April 04 2014

Letter from Across the seas : Mother of twins shares Hypospadias Surgery guide for parents

Letter from Across the Seas:

Dear Dr Singal,

Trust all is well with you. We are glad that we came all the way to India to you for our boys and are thankful to you for treating our boys with such care and in a single stage surgery for Hypospadias. As discussed, I have written the write up for the blog. These are basically my views, learnings and tips for other parents, especially the Hospitalization including pre-surgery and post hypospadias surgery course.

Regards,

S.P.

Dubai

THE WRITE-UP

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Dear Parent,

As parents we all are concerned for our child(ren)’s wellbeing. We interact a lot with Pediatricians and Specialist Pediatrician from birth till their teens. From Vaccinations to Major surgery we ensure our child(ren) gets best of the treatment and care. Until both my twin boys were detected with Hypospadias, I was inexperienced and the entire journey from initial diagnose to surgery has taught me a lot.

Here are some tips, learnings and guidance for parents

Before the meeting the Doctor

1. Most cases of Hypospadias are detected at birth. The Pediatrician at birth may not be expert enough to guide further so it’s better to consult a Pediatric Urologist or expert hypospadias surgeon as soon as possible.

2. There is no benchmark for earlier consultation, but its better the visit to the Pediatric Urologist when the child is less than 6 months old.

3. If you are an outstation patient and are communicating with the doctor over emails ensure you share following info:

Baby’s Allergies and medications
Any special medication or condition
Any hospitalization and the reason

Sometimes this information doesn’t affect the course of hypospadias surgery but its always safe to share as this helps the anesthesiologist for planning a safe anesthesia

4. If you have a limited timeframe for your visit than

Check if there are any further tests (like blood or urine tests) or investigations required before you meet the pediatric urologist
As required by the doctor, perform the tests and send the reports to doctor for further guidance. This can be done via email. Since I was traveling from Dubai, I did these tests as recommended by Dr Singal even before I landed up in Mumbai
Sometimes a certain blood count such a hemoglobin may be needed to be normal before hypospadias repair procedure is required to perform before surgery and if the count is not as preferred it may take month to reach the desired level.

5. Check for the travel plans of the doctor so that it doesn’t clash with your visit. Sometimes the doctor maybe traveling for vacation or for a conference.

6. Convey your travel plans to the doctor

Once you meet the doctor, most of your doubts will be cleared in the initial meeting. A date for hypospadias surgery will be decided in the meeting. If you have questions or doubts regarding the hypospadias treatment procedure please ask the doctor, he will be happy to guide. Sometimes you may have doubts or questions post consultation check with the doctor if you can email for such doubts. The doctor may suggest hospitalization before the day of the surgery and also some additional tests whenever needed.

My twin son’s both had hypospadias and we elected to have surgery for first kid on Monday and second one on Tuesday.

When we reached the hospital we had some minor issues as it was Sunday and we were supposed to see the doctor on call in ER. Since they were already alerted for our visit the doctor on call was prepared with all the requirements. They were to do a blood test on one of my twin. To avoid double prick they decided to insert cannula for one of my boys. And then the hell broke. We had two crying babies (one due to prick and other seeing the first one) and there were hospital formalities to be fulfilled.

Hospitalization

1. Before admission to the hospital

Reach hospital half an hour before the schedule time.
Insist – The Cannula And Blood Tests Be Done Only After The Kid Is Settled In The Room
Request for the allotment of room and fulfill all the formalities
Ask for hospital clothes for the baby
Change the baby in hospital clothes
Once the child is settled than ask doctor on call to the needful

2. Inform the hospital staff if your child is on a special diet and if they can provide.

3. Carry baby products – wipes, diapers, any special food or milk powder you may be giving, soft toys which soothes them

4. Carry you basic requirements for two days of hospitalization

5. Since the hypospadias operation will be done under anesthesia, check till when the child be given food/water/milk.

After Care

1. Learn to change the baby double diaper. We were happy as with double diaper technique the babies were nicely tugged in and there was little fear of catheter dislodgement.

2. Learn the medications of the baby

3. Don’t discontinue medication unless the doctor advise

4. Follow up visits with the doctor

The child will have discomfort and can be cranky due to operation the doctor will guide you. This is a normal phase after any surgery with children as penis is a sensitive organ and pain may be there for a first few days. But as one learned person said “ This too shall pass” It did pass for us. Now when we look back, the difficult days just went by in a jiffy. With the love and support of Dr A.K.Singal, junior doctors and nurses, we saw them through.

My personal advice – Stay Calm and positive through the process.

All the best

Regards,

An experienced Parent

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Please feel free to write to us for an opinion at hypospadiasfoundationindia@gmail.com or fill this contact form http://hypospadiasfoundation.com/contact-patient.htm

Watch videos on our Youtube Channel:

https://www.youtube.com/watch?v=HGRDZGXlffY

https://www.youtube.com/watch?v=M9_buN10lUE

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

December 12 2012

Dressings after hypospadias surgery – everything the parents should know about!

Why is dressing needed after hypospadias surgery (urethroplasty)?

As after any surgery, a dressing is required after hypospadias repair as well and the reasons for this are many.

The dressing helps to prevent infections by creating a physical barrier as well as supports the penis in the healing phase.
Penis is an organ which has a tendency to swell up after surgery or any trauma and thus a dressing helps to support the organ in the healing phase after hypospadias surgery.
Besides these two major goals, some surgeons use the dressings to prevent bleeding after surgery but with the refined techniques and more experience, bleeding has become less common issue surgery and we at hypospadias foundation generally use a very loose dressing as prevention of bleeding is generally not the goal for the application of dressing.

When we were in surgical training, we had a standard firm elastocrape dressing which used to be applied tightly and was resultantly difficult to remove. The advantage, though, was that it would remain in place without the risk of getting dislodged. On a personal front, as a resident doctor asked to remove those bulky sticky dressings, I was never happy with the dressing as it was difficult to apply, difficult to remove and I felt that it would cause too much of pressure on the healing tissue at the cost of impairing circulation. Also the healing area will not get air to breathe. I was worried that this may result in poor healing as well.

Over the last few years though the primary goals of dressings have remained the same, the dressing after hypospadias surgery itself in our practice has become very easy to apply and remove.

What we use is the following:

At the end of hypospadias surgery, we put a transparent cling wrap kind of dressing called – Tegaderm film- on to the penis – the operated site. This is light in consistency, does not stick to the tissues, is easy to remove and it allows passage of air through it thus aiding in healing.

Over the Tegaderm film, we apply a couple of rolls of thin white gauze just to support the penis and this layer is kept loose and just functions as a soft scaffolding.

A small piece of sticking tape called micropore is applied to hold the gauze piece and the catheter in place and this step finishes the dressing.

In some children, if the dissection has been extensive into the scrotum or the penis length is short we apply a sandwich type of dressing over the whole area instead of a rolled dressing.

Double diaper care- finally the catheter is brought out through a small hole in the inner diaper and left to drain in the outer diaper. Double diapers also help in keeping the area snug and dry during the healing process while allowing the children freedom of movement.

We believe a loose dressing after hypospadias surgery allows good blood circulation to operated area after surgery and thus faster healing. Also, we have observed that the pain is much less with this type of dressing. This dressing is also very easy to remove in the outpatient department during follow up.

What can go wrong with hypospadias dressings?

Dressings can get dislodged fairly frequently after hypospadias surgery. If this happens during first 2-3 days we like to do the dressing again in clinic. But if this happens after 3 days, we just remove the dressing completely and apply antibiotic ointment on the operated area 3-4 times a day and at every diaper change.

When do we remove the dressings

We generally remove the dressings on day 5-6 but in certain distal hypospadias we like to remove the dressings along with the catheter on day 7 after surgery. Removing them together avoids one opd visit for the family.

How are dressings removed after hypospadias surgery/ urethroplasty?

Dressings are removed in the outpatient unit by the junior doctor or the treating surgeon by gently teasing them out. Sometimes normal saline is used to ease out the dressings by making them wet. We have seen that tegaderm based dressings slip out fairly easily in clinic. The only caution to make sure that the catheter is not accidentally pulled up while loosening the dressing.

What happens if there is bleeding into the dressing?

Minor bleeding after hypospadias surgery is fairly common and happens as penis has very robust blood supply. Generally this occurs as a small amount of blood spotting or drops of blood at the tip of penis. If the bleeding stops by itself, nothing needs to be done and this is generally the case. If the bleeding is more in quantity, we ask the parents to visit us and a tighter dressing may need to be applied.

What happens if there is urine leakage into the dressing?

Small amount of urine leakage by the side of the catheter into the dressing is common. If there is lot of urine leakage by the side of the catheter then this means that the catheter may be blocked. The surgeon can then flush the catheter to relieve the block and the leakage will stop.

What happens if there is potty staining of the dressing

Sometimes the children may have loose motions after hypospadias surgery due to side effects of the antibiotics. These may then leak and stain the dressing. In such a case you should wash away the stools and visit the Hypospadias Foundation/ Mitr Hospital to get the dressing changed or removed. If dressing is left potty stained for long, this may allow the bacteria in potty to cause infection in the freshly operated hypospadias.

What care to take after removal of dressing

Child can be given warm tub bath twice a day and an antibiotic ointment should be applied on the operated site 4-5 items per day. Inner Diapers should be changed at least 2-3 times per day and outer ones as soon as they are full with urine.

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

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Category Archives: For Parents and Patients

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation