A 7-month boy was brought with complaints of passing urine from the underside of penis and incomplete foreskin. On clinical examination the meatus was at the corona with a deep glans groove and no obvious chordee. He was planned for a single stage hypospadias repair surgery.
Fig 1: Clinical picture showing coronal hypospadias
Marking of the degloving incision. Local anaesthesia with adrenaline was infiltrated at the marked incision site. Complete degloving was done and chordee was assessed using artificial erection test. No chordee was noted. Since, the glans urethral plate was wide and supple, a decision was made for doing a Glans Approximation Procedure instead of a TIP or Sonodgrass repair. Urethroplasty was done over a 7Fr Infant feeding tube with 6-0 PDS continuous sutures in two layers. Lateral Dartos flap was harvested for extra second layer coverage over urethroplasty which was sutured using 6-0 PDS. Glansplasty was done using 6-0 PDS. Skin was closed in 2 layers using 7-0 PDS. Dressing and catheter were in situ for 7 days. Following 7 days, the dressing and catheter was removed.
Fig 2: Complete degloving done to assess chordee.
Fig 3: Artificial erection test done – No chordee noted.
Fig 8: At 1 month post operative period on follow up his urine stream was straight with no deviation and meatus was at the glans.
Glans approximation procedure (GAP)
Glans approximation procedure is a hypospadias repair procedure which can be used to repair coronal and glanular hypospadias in a single stage. The ideal candidate for these repairs is the one with a wide meatus and deep glanular groove. With proper selection this procedure has an excellent cosmetic result with minimum complications.
The case described above is of a 7-month boy who presented to us with coronal meatus and deep glans groove. On examination there was no obvious chordee. He was planned for a GAP repair. During surgery an artificial erection test was done to confirm the absence of chordee. Urethroplasty was done and a watertight closure was achieved. Glans wings were widely mobilized for glansplasty. The dressing and catheter were removed on post operative day 7. He was passing urine in a single straight stream with no complications.
Case selection is essential for GAP repair. In experienced hands complications following GAP repair are almost none.
About Hypospadias Foundation
Hypospadias Foundation is a centre specialized for treatment of children and adults with hypospadias. Our expertise in hypospadias makes us one of the best centres for hypospadias repair surgery and treatment in the world. We treat children from more than 25 countries across the world and from all over India. Our dedication in this field has helped us achieve excellent outcomes. Hypospadias foundation is located at MITR Hospital in Kharghar, Navi Mumbai in the state of Maharashtra.
Dr A K Singal is an expert and one of the top hypospadias surgeons in India. He is a gifted surgeon and his expertise in this area has helped us achieve excellent outcomes in primary and failed hypospadias in children as well as adults.
Dr Ashwitha Shenoy is an expert pediatric surgeon with special interest in hypospadias and pediatric urology. Both Dr Singal and Dr Shenoy work together to give best results for hypospadias surgery in India for both children and adults.
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For appointment kindly contact us at the contact details given below.
MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai – Tue/Sat 4:00pm-6:00pm, Call for appointments: +91-2227743558/ 27744229/ 39/69 and +919324180553.
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