adult hypospadias surgery Archives - Hypospadias Foundation

June 06 2025

Enhancing success rates in adult primary hypospadias surgery

In the last few years, we have been treating a lot of adults coming with unrepaired primary hypospadias wanting to get hypospadias repair surgery done. Adult Hypospadias repair surgery is a very different ballgame from child hypospadias surgery. Traditionally clinical outcomes for adult hypospadias surgery have not been as good with pediatric hypospadias surgeries as:

1. Chances of infection are high
2. Due to erections at night, chances of dehiscence are high

After having done hundreds of adult hypospadias surgeries, we can clearly see differences in adult hypospadias and children with hypospadias. Whether it is the size of penis, overall anatomy of tissues, pre-surgery preparation, intra-operative instruments and stitches or post-op care- everything is very different. Over the years, we have understood various steps which should be done to decrease risk of hypospadias surgery complications in adults. This has led to improved results in adult hypospadias surgeries.

Our Stepwise Adult Hypospadias Surgery and Care protocol:

1.Pre- surgery counselling: We make sure that expectations are set right. While hypospadias surgery can correct the curvature, cosmetic appearance and urine flow issues, hypospadias surgery cannot increase the size of penis or improve fertility. In our hypospadias clinic, after we have examined the adult hypospadias patients, we discuss what they want and the propose the outlined treatment plan.

2. Pre-surgery tests: Before hypospadias surgery is planned, we like to do blood tests for ruling our diabetes, check out any risks for anesthesia or any infection. We also like to do a urine routine test to check for any infection. Chest Xray and ECG test are done to make sure that the person is fit for anesthesia. We also take a consult from a physician to make sure that the
person is fit to undergo anesthesia for hypospadias surgery.

3. Pre-surgery preparation: We start a betadine scrub bath for cleaning pubic area twice daily 2 days before surgery. Pubic hairs are not shaved as shaving 1-2 days before surgery can lead to higher risk of infections. Typically, we trim the hair in the OT with a hair trimmer.

4. Surgery: General anesthesia with epidural block is given. All aseptic precautions are taken to prevent infection. Special microsurgery adult hypospadias instruments are used. Sutures used are also absorbable ones. Care is taken to handle tissues, nerves and blood vessels very gently. Dressing is done to support the penis and catheters are secured properly. Once the patient is out of anesthesia, we shift out to recovery room and thenward.

5. Post-Surgery care: We give IV antibiotics for 2 days and also open the dressing on day 5 to check for any infection. For some cases, we also advise hyperbaric oxygen therapy for 5-7 days. Catheter in adult urethroplasty is kept for a longer period as healing is slow. We typically keep two catheters – a suprapubic catheter and a urethral catheter. Both are kept for 3 weeks.

6. Follow-up: After urethral catheter removal, we typically clamp the suprapubic catheter and once the patient is passing urine from urethral well, we remove the suprapubic catheter after 2 days.

By following this protocol, our results in adult primary hypospadias surgeries have become the best in India and amongst the top centres in the world. Our success rates in Adult Hypospadias Surgery are over 95% in primary one or two stage repair with very less number of people needing further surgeries. At Hypospadias Foundation, a dedicated team of surgeons takes care of adult hypospadias. Dr A.K.Singal is a reputed and top hypospadias surgeon who has been doing hypospadias repair surgeries since 2006 and is rated amongst the best in the world for clinical results. Dr Ashwith Shenoy is a hypospadias surgeon who has deep experience in managing hypospadias. Both of them work closely giving best outcomes to adults with hypospadias. Given their team work and dedication to success rates in hypospadias, it is no surprise that people come from all over India and more than 20 countries to seek hypospadias treatment under their care.

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May 05 2025

Outcomes for adult hypospadias surgery: What surgery can and cannot achieve for you!!

Adult hypospadias surgery is fundamentally different from operating on a child. When we started hypospadias foundation in 2008, we started with an aim to help children with hypospadias and DSD get better outcomes. In 2015 we started getting lot of enquiries from adults with hypospadias. We realised that neither adult urologist or pediatric surgeons or plastic surgeons are equipped to deal with a congenital anomaly like hypospadias in adults. Whether it a primary non-operated hypospadias in an adult or a failed hypospadias repair in an adult, it is very different from the children. Hence, it is very important for the hypospadias surgeon to set the right expectation during the counselling session before hypospadias repair surgery. Unless the expectations are matched, no one is going to be happy after surgery.

Dr A.K.Singal and Dr Ashwitha Shenoy operating on a patient with hypospadias

What can adult hypospadias surgery accomplish:

1.Straight penis by chordee correction: If the person has a hypospadias with a bent penis, it can be fully corrected, and a straight penis can be achieved. We use a variety of chordee correction techniques like 16 dot plication Chordee correction surgery in an adult redo hypospadias using 16 dot plication in adults to achieve good outcomes.

2.Achieve urine opening at the tip: In almost all primary hypospadias, we are able to achieve an urinary opening on the tip of penis. In failed hypospadias or ones with previous surgeries (unless the glans -the head of penis- is damaged), with modern techniques, we are able to achieve opening on the tip. Rarely, if there is fibrosis or deformed glans due to previous surgery- we try to bring the opening as close to the head as possible.

3.Good Cosmetic result: In most of adult hypospadias, we are able to achieve a good cosmetic result with a straight penis, opening on the tip and a circumcised appearance. With modern stitches, good instruments and trained expert hypospadias surgeons, the stitch marks are also very less. Single stage hypospadias repair in an adult

4.Ease in intercourse: Some of the adults come to us with difficulty in intercourse due to chordee. Once chordee is corrected, the intercourse becomes painless and easy.

5.Standing up and passing urine: One of the chief complaints in hypospadias is that the urine goes backwards. Hence, the male has to sit to pass urine. This is especially true for proximal penile, penoscrotal or scrotal hypospadias. Once hypospadias is corrected, the urine goes forwards and the person can stand up and pass urine like a normal man. (urine stream pic)

6.Straight stream without spraying: Most of unoperated or failed hypospadias repair come to us with spraying of urine. This happens when the urine hole is not on the head, the urine doesn’t get a proper direction to form a nice stream. Once the hypospadias is corrected, urine starts coming in a normal single stream from the head of the penis and directed forwards without spraying.

7.Passage of urine from one hole: Some of the failed hypospadias cases may have multiple holes due to urethral fistulae. Due to these the person may be passing in 2, 3 or more streams. We have seen cases where the person was passing urine like a watering can due to multiple holes. This can all be corrected with successful adult hypospadias surgery by an expert surgeon.

8.Healthy mental state: We have seen lot of young adults, who feel inferior and incomplete due to a deformed penis because of hypospadias. They often are hesitant to establish relations with opposite gender. Once repaired with a good result, these men report higher mental self esteem and comfort in establishing healthy relationships. If the depression and anxiety is severe, it is a good idea to discuss with your surgeon and take some psychology help before and after surgery,

What adult hypospadias surgery cannot accomplish:

1.Increase in penis size: Hypospadias surgery leads to correction of anomaly but not an actual increase in size of penis. In some cases with severe chordee, unrepaired penis may look small due to chordee. Once we correct such cases, the penis may look longer due to straightening of the penis.

2.Solve premature ejaculation: Premature ejaculation is not related to the hypospadias and hence surgery can’t solve this. For such issues we refer the cases to adult urologist for treatment.

3.Erectile dysfunction: Some men with hypospadias come with erectile dysfunction, generally this is not related to hypospadias itself. It may be psychological or due to some other anomaly. Hypospadias by itself doesn’t cause erectile dysfunction and repairing hypospadias doesn’t improve it either. For such issues we refer the cases to adult urologist for treatment.

4.Cure infertility: Hypospadias may cause difficulty in intercourse if there is severe chordee but generally doesn’t cause infertility. Hence, if the sperm count is low or poor, doing a surgery will not solve this. For such issues we refer the cases to adult urologist for treatment.

It is important that adults with hypospadias discuss these issues threadbare with their treating hypospadias surgeon before surgery. We also take help of a clinical psychologist or an adult urologist whenever needed before surgery to set the right expectations. At Hypospadias Foundation India, we are dedicated to helping adults and children with hypospadias get the right diagnosis, full counselling, expectation setting and surgical treatment with empathy. With both the surgeon and the patient aligned, great outcomes and happiness can be achieved.

Dr A.K. Singal is rated as the best hypospadias surgeon in the world for adult hypospadias surgery. Dr Ashwitha Shenoy is a well-trained pediatric urologist and hypospadias surgeon working with Dr Singal. Together as a team both of them treat hundreds of adults and children with hypospadias from across India and the world every year with best care and results. With advancing experiences, the complications of adult hypospadias have decreased significantly, and success rates are above 96% at Hypospadias Foundation.

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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. Hypospadias cause male infertility in certain cases due to these complications. 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 the penis to the tip of the 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 the base of the penis (penoscrotal hypospadias) to near the tip of the penis (distal hypospadias). Besides the misplaced opening, most men with hypospadias also have a downward bending of the penis during erection – called chordee. Hypospadias can cause male infertility as 5% of cases may also have an associated undescended or 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, and you suspect hypospadias cause male infertility, 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/

February 02 2019

Single stage buccal mucosa graft urethroplasty for an adult with failed hypospadias

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias is a common congenital birth defect which occurs in 1/150 boys in India. 20-30 years back the treatment for hypospadias was very not very successful as the procedure and surgical techniques very not very refined, the number of expert hypospadias surgeons focussed on treatment was less, sutures and instruments for hypospadias surgery were also very basic. With advancing knowledge and expertise, these days in 2019, the results of hypospadias repair (urethroplasty) are much better. A lot of adults in this century, underwent surgery as children way back in 1980’s and 1990’s and some of them did not get good results even after multiple hypospadias surgeries due to complications. Some of these people lost hope at a cure and did not pursue further surgery for failed hypospadias. At Hypospadias Foundation, we regularly get such young adults who come from all over India to seek best treatment and cure for Hypospadias. One of the new techniques to cure such adults with hypospadias is to use skin from inside the mouth for making new urethra- called oral or buccal mucosa graft urethroplasty. In hands of an expert surgeon, it has extremely good results.

Case History:

Mr A.G. 26 years old young man, engineer by profession, extremely smart and suave in nature, came to our hypospadias clinic one evening. He sat down and talked about the trauma of two failed hypospadias surgery which he underwent in Indore with a plastic surgeon. The last surgery was about 10 years back. He had lost hope for cure till he stumbled upon Hypospadias Foundation while searching online. He had come with a hope to get a cure for his hypospadias issue and get married soon. His present problem was thin stream of urine, pain while passing and leak of urine from underside of penis. On examination, his penis was straight (no chordee), he had a fistula in proximal penile region with thin unhealthy urethra. We sat with him and explained the plan to do a cystoscopy and check for quality of urethra and find out reason for repeated failure of surgery and then decide whether a one stage or two stage surgery is needed for full cure and best results of hypospadias surgery. A.G. agreed for the plan and wanted the best treatment.

Surgery:

On cystoscopy, we saw that his new urethra was thin and unhealthy. We cut it open from tip of penis to the site of fistula and actually little below that. We saw that the dorsal wall (roof of urethra) was healthy with minor scarring. We made a deep cut in the dorsal wall in the central midline. We took a buccal graft (oral or labial graft) from upper lip. The graft was fixed with absorbable sutures in the midline to form a part of the neo-urethra. The graft and surrounding urethral wall were rolled into a tube with absorbable sutures around a 14 Fr silicon catheter – all in one stage. The unhealthy skin was excised, and closure of skin also done in a cosmetic way. The catheter was removed after 3 weeks and at one month after catheter removal AG was passing urine in a thick stream without pain from the tip of penis. He was very happy and planning to get married soon. We advised him to marry atleast 6 months after hypospadias surgery. The new urethra is still a bit fragile for 3-4 months after surgery and it is better to wait for 6 months for intercourse (coitus/ sex) after surgery.

Buccal (oral) mucosa graft urethroplasty in adults:

An adult with multiple failed hypospadias surgeries, generally has no normal penile skin or prepuce left for hypospadias repair using local tissues from penis. Hence in such patients, it may be better to use skin from inside the mouth for making the new passage. The skin can be easily taken from inside of cheek or lips. The defect heals very fast and generally without much complications. The buccal graft adapts to penile location very well and has great long-term results in failed surgery. While some of these cases are suitable for a single stage surgery, some may require two stage surgery depending on the severity of the defect. Nonetheless, Buccal Graft Urethroplasty remains a great option with best long-term results for children and adults with Failed Hypospadias.

At Hypospadias Foundation in India, Dr Singal and his team have one of the best hypospadias surgery results in the world. Children and adults from more than 20 countries such as UAE, Bahrain, Iran, Iraq, Afghanistan, Saudi Arabia, Pakistan, Bangladesh, Malaysia, Tanzania, Nigeria, Congo, Ethiopia, Kenya, Nepal, Indonesia, Egypt, Jordan etc come for treatment at our foundation. It is indeed heartening to see them go back with final cure from hypospadias.

To contact us write an email to hypospadiasfoundationindia@gmail.com or contact us at +91-9821261448 between 9am-6pm India time or fill up this form for enquiry.

Watch Buccal Mucosa Graft Urethroplasty Video here:

Watch Two staged Buccal Mucosa repair surgery in a child:

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What can adult hypospadias surgery accomplish:

What adult hypospadias surgery cannot accomplish:

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