Primary Hypospadias Archives - Hypospadias Foundation

February 02 2026

Single stage hypospadias repair in distal penile hypospadias with chordee

Mast A.T., a one-year-old male, presented to the Hypospadias Foundation clinic with an abnormal ventral urinary opening on underside of penis and downward penile curvature. Clinical examination revealed a distal penile hypospadias, deficient ventral foreskin, and
ventral chordee (penile curvature).

A single-stage surgical hypospadias repair was planned, comprising of chordee correction (Orthoplasty) and urethroplasty (reconstruction of the urinary channel)

Intraoperative Procedure

The procedure commenced with a 5-0 Prolene stay suture on the glans for traction. Local anaesthesia (Xylocaine with adrenaline) was infiltrated at the marked incision sites. Following the initial incision and complete degloving of the penis, an artificial erection test was performed to assess the degree of curvature.

 Chordee Correction: A curvature of less than 30 degree was noted. This was corrected via Tunica Albuginea Plication (TAP) on the dorsal aspect (upper part) of the penis, opposite the site of maximum curvature. A repeat artificial erection test confirmed complete correction of the chordee.

 Urethroplasty: The glans wings were marked, incised, and widely mobilized. A midline incision was made in the urethral plate to increase its width (TIP – Tubularized Incised Plate technique). The neo-urethra was constructed in two layers:

o Layer 1: Continuous subcuticular sutures.
o Layer 2: Interrupted sutures.

 Waterproofing: A preputial dartos flap was raised and transposed over the urethroplasty site to provide a vascularized waterproofing layer, significantly reducing the risk of a fistula (leak).

 Completion: Glansplasty was performed to reconstruct the glans. The skin was closed in two layers using 6-0 PDS and 6-0 vicryl Rapide.

Postoperative Outcome and Follow-up

The repair was stented using a 7 Fr infant feeding tube, with the new meatus successfully positioned at the tip of the glans.

 Day 7: The catheter and dressings were removed. The patient demonstrated a strong, straight urinary stream with no associated pain.

 Healing: The surgical site healed by primary intention without complications (e.g., hematoma, infection, or dehiscence).

 1-Year Follow-up: The patient remains asymptomatic with excellent functional and cosmetic results.

Pic 1: Clinical examination shows presence of chordee with meatus in the distal penile region

Pic 2: Complete degloving done

Fig 3: Artificial erection test shows less than 30-degree chordee which was corrected by 12’o clock dorsal tunica albuginea plication (dorsal TAP)

Fig 4: Glans wings raised and urethroplasty done over 7Fr infant feeding tube. Right dartos flap raised and sutured over the urethroplasty with 6-0 PDS.

Fig 5: Single stage urethroplasty with chordee correction completed

Fig 6: At 7 days follow up after surgery

Fig 7: At 1 year follow up after surgery, passing urine in single straight stream

Single-stage hypospadias repair in distal penile hypospadias with chordee Single-stage hypospadias repair is the preferred surgery for distal penile hypospadias associated with mild chordee. Though the urinary opening is positioned near the glans, the reconstruction has to be done with utmost care by the hypospadias expert.Even a little bit of carelessness can lead to complications.

 Primary Technique: The Tubularized Incised Plate (TIP) urethroplasty—commonly referred to as the Snodgrass repair—is the most widely utilized method. This procedure involves a midline incision of the urethral plate to allow for tension-free tubularization, ensuring a functional and cosmetically normal neo-urethra.

 Optimal Age for Surgery: Pediatric urologists generally recommend performing this repair between 6 and 18 months of age. This "golden window" facilitates rapid tissue healing, simplifies postoperative diaper management, and minimizes the risk of long- term psychological impact on the child.

Outcomes and Success Rates

When performed by an expert hypospadias surgeon in a specialized center like Hypospadias Foundation India, the success rate for distal repairs exceeds 95%. However, clinical diligence is required to monitor for potential postoperative hypospadias complications.

Functional Rationale for Early Surgical Intervention

While distal hypospadias may appear manageable in infancy, untreated cases often lead to significant functional and psychosocial challenges as the patient matures:

1. Backward flow of urine: If the urinary opening is located on the underside of the penis, the stream is directed backwards causing inconvenience to the boys. Boys will have difficulty in using a urinal and they cannot urinate without getting urine on their clothes or shoes.

2. Sexual Health: Persistent chordee (ventral curvature) can lead to painful erections or Mechanical difficulties with intercourse in adulthood.

3. Psychosocial Impact: A non-apical urinary opening can cause significant social anxiety and hygiene concerns regarding standing to void.

Clinical Summary: Early repair of distal hypospadias with chordee is not merely cosmetic; it is a functional necessity that ensures optimal urogenital health and quality of life into adulthood.

The Hypospadias Foundation: A Global Center of Excellence

Located in Kharghar, Navi Mumbai, Maharashtra, the Hypospadias Foundation stands as India’s premier and best hypospadias specialty center and a globally recognized leader in hypospadias treatment.

Why Patients Choose Our Center:
For over 18 years, we have been a destination for both pediatric and adult patients from across India and the world. Our commitment to surgical precision and patient care is reflected in our clinical data:

 High Volume: Over 250 specialized surgeries performed annually.

 Proven Safety: A complication rate of less than 5%, significantly lower than the global average for complex reconstructions.

 Global Reach: Successfully treating international patients from more than 30 countries with diverse anatomical challenges.

Our Expert Surgical Team

The foundation’s success is built on the combined expertise of two of the world’s leading specialists in reconstructive urology.

Dr A. K. Singal is a top-tier expert hypospadias surgeon and pediatric urologist who has dedicated his career to the advancement of hypospadias repair. His refined techniques have consistently achieved excellent functional and aesthetic outcomes for both children and adults, particularly in complex "redo" or failed previous surgeries. He is rated the best hypospadias surgeon in India and the world.

Dr Ashwitha Shenoy is an expert pediatric urologist with a sub-specialty interest in pediatric urology and hypospadias. Her meticulous approach to neonatal and childhood reconstruction ensures long-term success from a young age. Together, Dr. Singal and Dr. Shenoy provide a collaborative, multidisciplinary approach that delivers the best results for hypospadias surgery in India.

September 09 2023

A child with Severe Hypospadias – Modified Koyanagi urethroplasty

A 1.5 years old boy was referred to us from Goa with severe hypospadias and chordee, diagnosed as scrotal hypospadias with chordee. The urinary opening was near the end of the scrotum. The penis was also significantly bent (chordee). Since our center specializes in single-stage urethroplasty, we decided to do a single-stage repair, specifically Child Severe Hypospadias Koyanagi urethroplasty.

As a first step, the penis was degloved and the chordee was corrected using 12 O’clock tunica plication. The Koyanagi flaps were raised on either side, going on the top of the penis, and these were then joined together in the midline and finally tubularized using 6-0 PDS over 8 Fr stent.

Second layer coverage was done with Tunica Vaginalis flap and prepuce on top was split in midline and brought ventrally or coverage of skin. The child did very well and required no further surgery.

August 08 2023

A child with Severe Hypospadias – Prepucial tube urethroplasty

Master VM, a 1.5-year-old boy with severe hypospadias, was brought to the clinic from Surat. On examination, the urinary opening was scrotal in location. There was significant chordee also. The final diagnosis thus was Scrotal Hypospadias with chordee. Everywhere else, he had been advised a staged urethroplasty requiring three surgeries. A single-stage urethroplasty was planned for the child with severe hypospadias. As the first step, the penis was degloved to obviate the chordee. Even after degloving, significant chordee was still seen. A 12 O’clock tunica albuginea plication stitch was taken, and the penis was straightened. The chordee correction test showed no residual chordee.

A decision was made to make a tube from the dorsal prepuce and use it as a new urethra by rotating it towards the underside of the penis. This is called a single-stage “prepucial tube urethroplasty,” one of the complex repairs for severe hypospadias.

A prepucial flap was outlined and was harvested with good dartos blood supply. This was then brought ventrally and sutured to midline tunica albuginea with PDS to lay a base for tubularisation. Then this flap was tubularised over a 7Fr catheter as a new urethra Glans repair and a new urethral opening was made. The prepuce was split in midline and brought towards underside to cover the new urinary passage.

August 08 2023

A boy with scrotal hypospadias – Transverse Island Onlay Flap urethroplasty

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.