Hypospadias Surgery Archives - Hypospadias Foundation

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.

September 09 2018

Hypospadias Foundation starts Clinic in Bahrain

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias surgery is a very delicate, specialised and rare surgery. It requires years of training, very special interest and dedication to get good results from hypospadias surgery. Often the first surgery is the best hope for cure from hypospadias, once there is a failure at first surgery, subsequent surgeries become difficult and results poorer. Hence, it is recommended that hypospadias treatment should be conducted only by trained pediatric urologists and hypospadias surgeons.

At Hypospadias Foundation in India, hundreds of children come from all over the world to seek treatment either for primary or for failed hypospadias. Children from more than 20 countries have benefitted from surgical expertise and caring attitude of team at Hypospadias Foundation located at Navi mumbai, India.

Many these children come from middle east, Gulf/ GCC countries and MENA region to India. While we get more than 50 enquiries a month from countries such as Bahrain, Saudi Arabia, Oman, UAE (Abu Dhabi/ Dubai), Qatar, Kuwait, Iran, Iraq, Jordan, Kenya, Tanzania, Nigeria – many of them find it difficult to come to India as some of these children may require multiple surgeries if the hypospadias problem is complex or they have failed surgeries elsewhere.

Sensing this acute gap in quality of hypospadias care, Hypospadias Foundation has started a Pediatric Urology and Hypospadias Clinic offering consultations and surgeries in Bahrain. The centre is located at Ibn Al Nafees Hospital in Manama, a renowned hospital with good facility and excellent reputation for good quality care of children.

The Hypospadias and Pediatric urology centre will offer consultations, diagnosis, pre and post-surgery care, surgery for various Pediatric urology disorders including hypospadias. The centre is run jointly by Dr A.K.Singal, Hypospadias Surgeon & Pediatric Urologist from Mumbai, India and Dr Mahmood Abbas, Senior Pediatric Surgeon trained in France and living in Bahrain.

Dr A.K.Singal is considered as one of the best hypospadias surgeons worldwide. Every year he treats kids from all over the world for primary, severe, complex and failed hypospadias. Dr Singal’s experience in Hypospadias surgery is one of the largest single surgeon hypospadias treatment experience in the world.

Dr Singal said,” Every month we receive enquiries via email from children of parents living in Gulf, Middle East and MENA region for hypospadias. It is indeed cumbersome and expensive for them to travel to India for surgery and treatment of hypospadias. Our association with Ibn Al Nafees hospital, Manama, Bahrain will offer them care and surgeries for hypospadias within a more accessible and familiar location in the beautiful country of Bahrain. The centre will also focus on offering treatment for other child urology conditions such as hydronephrosis, reflux, infections, incontinence, undescended testis (cryptorchidism), megaureter and kidney stones.

Dr Mahmood Abbas added, “Myself and Dr Singal have formed a team to start Hypospadias and Pediatric Urology Clinic at Ibn Al Nafees Hospital to ensure that children with hypospadias and pediatric urological conditions get the best treatment. Even children who have failed earlier hypospadias surgery, can be managed with advanced surgery and novel techniques.”

Here is how to contact Hypospadias and Pediatric Urology Clinic at Ibn al Nafees Hospital, Manama, Bahrain:

Address:

Ibn al Nafees Hospital,

Rd No 3302, Manama, Bahrain

Appointments:

Dr Mahmood Abbas

Ibn Al Nafees Hospital

Phone: +973-17828246, 28247, 23209

By Whatsapp: +973-39467333

Email:

Hypospadias.bahrain@gmail.com

October 10 2012

Should a distal hypospadias be repaired!!

I did not know what was in store for me – there was 6 new patients in clinic and only 4 follow-ups and by the nature of it new patients take more time and follow-ups finish very fast. Anyway, the first patient who walked in was a 3 year old accompanied by young smart looking parents. The boy flashed a big smile and I said hello and he was eager to shake hands. That was a positive sign – Acceptance of me as a friend. Good so far.It was a nice Saturday evening, the watch clicked 7pm and I was in my Pediatric Urology clinic at Vashi with the last 10 urology appointments and was slated to be back home by 8pm.

Invariably on Saturdays I get late but today I was all energized to finish consultations fast and head back home for a quiet dinner and then catch up on much neglected sleep.

Then we got down to the business of consultation- the parents had looked up about hypospadias on internet and had found me and then travelled all the way to Navi Mumbai on a Saturday evening for a consultation for their little one who had hypospadias. I examined the eager and cooperative kid- he has a coronal hypospadias with mild tilt of glans (the head of penis). There was no chordee (actual bend of the body of penis) and testes were in normal location. Overall, it looked like a milder distal hypospadias which should be fairly easy to repair with a predictably good result.

I explained everything about hypospadias – how it happens and how it is repaired and then the QA began. The parents asked – “Is it necessary to repair it? We have heard that it can lead to long term urinary problems and sexual dysfunctions as sometimes the nerves get cut during sensation leading to a numb penis. Also, there are blogs which talk about no need to do surgery in distal hypospadias as there may be long term complications like hair growth, tight passage, fistulas etc.” They had visited an eminent Urologist who had advised against surgery.

Well, they had done their due research and it was good but sometimes the truth out there may not be whole truth. I had to counsel them and make sure that they know the whole truth while at the same time sounding detached from the whole process. It was after all their kid and their responsibility- my job was to give full, fair and medically sound information and then their job was to make the right decision for their kid.

So here are the facts as I discussed with them:

As the boy grows and finally the penis size become adult like, the deformity becomes more and more obvious. The glans (penis head) which was tilted will look more and more abnormal.
The prepuce will only be on the top of the head and not on the underside leading to an incomplete prepuce. It looks rather like the head of a cobra in adulthood
The urinary opening will be on the underside of penis and the urine stream will always be downward instead of forward as in a normal child.
The problems as stated above will be more cosmetic than functional but they affect the psyche as he will be able to see that the shape and configuration of his penis is quite different from that of other children. This can lead to deep seated emotional and social withdrawal issues in teenage and adulthood.
Repairs are easier with predictable and better results in childhood. Later on in teenage and adulthood repairs have higher failure rates and pain. Further erections can cause pain and instability in the repaired area after surgery.
The blogs out there contain stories of people who underwent surgery for hypospadias in childhood and now are adults. Thus the care which they received was 20-25 years back. The art & science of Hypospadiology has moved at much faster pace in last two decades and now- the understanding of anatomy of penis & hypospadias is much better, the surgical techniques have evolved and most of the repairs are done in single stage, new instruments for finer surgeries are available, new fine absorbable & non-reactive stitches are available and above all there are doctors who are well trained in managing the children with hypospadias.
Earlier surgeries using skin from scrotum or other body tissues are not done any more so currently any repair causing hair growth in urethra is outdated and not done by surgeons.
Complications like fistula, tight passage (stricture) are less than 5% in experienced, trained surgeons hands for milder distal hypospadias.

To sum up, it is worthwhile to repair distal hypospadias considering all the above. The science of hypospadias surgery has made sure that the children get the best results for surgery in their early childhood and then live their lives normal without worrying about their reproductive organs.

Contact Form for Hypospadias Foundation

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

July 07 2012

How to prevent failures in Hypospadias Surgery (Urethroplasty)

Hypospadias is a complex and challenging clinical problem. Worldwide accepted failure rates for single stage hypospadias repair (urethroplasty) are 5-10% and these children who have encountered a failure require a second surgery. This situation is never pleasant for the surgeon or the parents or the child who is actually undergoing another surgery. The key thing to understand here is that everyone including the parents and the doctors are on the same side in this situation and everyone wants the child to get better.

Infact when the parents come and see me in the clinic and ask about my second surgery or failure rates – I often tell them “I want your kid to have only one surgery, you want your kid to have only one surgery and the whole reason why you came to meet me and came to know that there is someone called Dr Singal is that your son has hypospadias. Our goals are, thus, aligned towards pursuing a good result with only one surgery in mind but at the same time realizing that inspite of our best intentions and experience and all the money and the efforts, 5% of the kids may still require a second surgery. Another reassuring fact is that the second surgeries are often minor with faster recovery and overall at the end of it all the child would be absolutely normal in almost all the cases. The only difficulty is to assess with full surety which child will have a failed surgery. For the child whom the second surgery becomes a reality the individual failure rate is thus 100% and for the rest the result is 100%”

Fortunately, there are some fine pointers which tell us about the increased risk of second surgery. These are:

Severe hypospadias
Severe chordee (the penis is very bent)
Associated issues like chromosomal problems or disorder of sex development.

The steps which one takes to avoid failure in hypospadias have to be titrated for each case thus giving each child undivided individual attention and care. Some of the mantras in avoiding pitfalls are:

Spending enough time to understand the subtle nuances and variations in anatomy of every case.
Proper selection of technique of surgery- single most important step in ensuring good outcome. There are over 100 techniques described for hypospadias repair. Most of the surgeons master 4-5 techniques and then for every case we have to diligently assess and assign a technique. This is best done at the time of surgery in the operation theatre. That is why a proper training, experience and dedication is very important in assuring good results. Pediatric urology training allows a surgeon to be flexible in the approach and decide at the last moment and even change the technique if something is not working out. It is akin to waiting for a ball to spin and then playing a shot called “late cut” in cricket. The whole hypospadias repair mirrors that philosophy.
A thorough re-operative assessment of the child for nutritional and health status is very important. The hemoglobin should be atleast 10gm% and the overall child should be well nourished so that the tissues will heal faster and better after surgery.
Fitness for anesthesia: Hypospadias surgeries require general anesthesia for the child. It is very important that blood tests and urine tests are normal for the child. Also, a very good clinical examination is done to make sure that the child does not have any other coexisting abnormality of infection such as chest infection, cough, cold, diarrhea or skin infection. Infection anywhere in the body makes the body weak as the body is consuming energy in fighting the infection and thus healing would be delayed. Also, there is a risk of a cross infection in the operated area. Since hypospadias is not an emergency, ideally we should wait till the child is fully well and in the “Pink of the health” (so to speak) before surgery.
Planning the surgery in a dedicated, good, well equipped & sterile operation theatre to prevent infection
Having microsurgical instruments which are dedicated only towards hypospadias repair and not used for any other surgery. Infact I personally have 3 such sets allowing me to sometimes perform 2-3 hypospadias repairs in one day
Using a magnifying loupe during surgery to perform surgery with finesse. Magnification helps in proper and fine dissection of tissues. Also the stitches used are of very fine caliber so magnification helps in tying knots properly.
Working with fine sutures- this goes hand in hand with using magnification since using magnification allows surgeon to use finer sutures.
Trained staff for surgery and post-operative care.

In the end it is important to remember that for a child with hypospadias, first surgery is the best chance at a complete functional and cosmetic result. Pediatric Urologist and the medical team should make sure and do whatever in their power to give the child a 100% result in the first stage.
natural penis enlargement pills

Contact Form for Hypospadias Foundation

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

Category Archives: Hypospadias Surgery

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation