Hypospadias is a congenital condition in which the urinary opening (meatus) is located on the underside of the penis instead of at the tip. Hypospadias repair surgery is a well-established and successful procedure that can be performed in infants, children, adolescents, and adults. However, choosing the best age for hypospadias repair plays an important role in healing, recovery, and long-term outcomes.

What Is the Best Age for Hypospadias Surgery?

Most expert hypospadias surgeons recommend performing surgery between 6 and 18 months of age. Surgery before 3 years of age is considered ideal, and if someone misses this period, surgery before 8 years of age is still strongly recommended if early repair was not possible.

Hypospadias Surgery in Infants (6–18 Months)

The ideal age for hypospadias surgery is between 6 and 18 months. At this age:

• Penile tissues are soft, elastic, and heal faster
• Scarring is minimal due to high tissue regeneration
• Infants are unaware of their genitalia and body image
• There is no psychological impact or memory of surgery

Early hypospadias repair also allows normal toilet training and smooth bladder control development. Post-operative care is easier in infants, as diaper changes simplify wound care and recovery is less stressful for parents.

Older children:

• Are more aware of their genitalia and may feel shy or anxious
• Experience more fear and perceived pain after surgery
• May find dressing changes difficult
• Sometimes hold urine after catheter removal due to fear of pain

Despite these challenges, healing and success rates remain high when surgery is performed by an experienced hypospadias surgeon.

Hypospadias Surgery in Teenagers

Teenage boys with untreated or failed hypospadias often feel embarrassed and reluctant to undergo surgery. In cases of hypospadias with chordee (penile curvature), we recommend delaying surgery until penile growth is complete. Avoiding surgery during active growth may prevent interference with natural penile development

Hypospadias Surgery in Adults

Hypospadias repair in adults is possible and can be highly successful. However, recovery is slower compared to children because:

• Adult penile skin is thicker and less elastic
• Healing takes longer
• Pubic hair can affect wound care
• Night-time erections may stress sutures and increase complication risk
• Infection issues are higher
• Urethral and extra safety supra-pubic catheter are also needed.

Even in adulthood, good outcomes are achievable in expert hands. Adult hypospadias surgery success rates at Hypospadias Foundation India are over 95%, which are best in the world.

Is There an Age Limit for Hypospadias Surgery?

There is no upper age limit for hypospadias surgery. The success of repair depends more on the experience of the hypospadias surgeon than the age of the patient. With proper evaluation and surgical expertise, excellent results can be achieved even in adulthood.

Importance of Choosing an Expert Hypospadias Surgeon

Before planning hypospadias surgery, it is essential to consult a specialist hypospadias surgeon. An experienced surgeon will:

• Carefully examine the child or adult
• Assess severity, chordee, and previous surgeries
• Recommend the best timing and surgical technique

At Hypospadias Foundation, children and adults from over 30 countries undergo hypospadias repair. The oldest successfully treated patient was a 50-year-old man with failed hypospadias repair and urethral stricture, operated without complications. This highlights the importance of choosing a specialized center for hypospadias treatment.

Dr A K Singal is a highly experienced and internationally renowned hypospadias surgeon in India, widely regarded as one of the leading experts in hypospadias repair for both children and adults. He has dedicated his professional life to the treatment of complex and failed hypospadias cases, helping patients achieve excellent functional and cosmetic outcomes.

With decades of focused experience in primary and redo hypospadias surgery, Dr Singal’s expertise has contributed to consistently high success rates in infants, older children, adolescents, and adults with hypospadias.

Dr Ashwitha Shenoy is an expert pediatric surgeon with a special interest in pediatric urology and hypospadias surgery. Her training and experience in managing hypospadias in children ensure meticulous surgical care, age-appropriate planning, and excellent long-term outcomes.

Together, Dr A K Singal and Dr Ashwitha Shenoy work as a dedicated team to provide comprehensive hypospadias treatment in India. Their combined expertise allows them to manage simple to complex hypospadias cases, including failed repairs and adult hypospadias, delivering some of the best outcomes for hypospadias surgery in India.

Contact us:

For appointment kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India – Tue/Saturday 4:00pm-6:00pm, Call for appointments: +91-6262840940. Or email us at hypospadiasfoundationindia@gmail.com

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.

25-year-old adult presented to the Hypospadias Foundation OPD with complaints of severe ventral curvature of the penis. There were no urinary complaints. He also that the curvature has worsened over time. There were no urinary complaints.. On examination, there was severe ventral curvature (downward bending) of the penis- the curvature was almost 90 degrees. Meatus was located on the glans and was normal in location. No plaques were felt on palpation. Ultrasound doppler of the penis was done which was normal. He was counselled for chordee repair surgery.

The plan was to deglove the penis, examine everything once again in detail including degree of curvature, urethral calibre and then decide for a single stage or a staged chordee correction repair.

Surgery was started by taking a stay stitch on the glans with 4-0 prolene. Marking of the degloving incision was done and local anaesthesia (lignocaine with adrenaline) was injected at the marked site. Complete degloving was done. Chordee was assessed by artificial erection test and more than 60-degree chordee was noted. Since the penile length was good and urethra was not appearing short or taut, we decided to proceed with dorsal plicationprocedure to correct the chordee.

Buck’s fascia along with neurovascular bundle was raised on the dorsal side starting laterally and upto the midline. Chordee was reassessed and exact site of curvature was marked. 24 dots (12 dots on either side) were marked. 4 dots proximal and 8 dots distal to the site of maximum curvature. Longitudinal plication sutures were placed at these sites with 4-0 prolene involving full thickness tunica albuginea. The sutures were first held tight without tying them up and chordee was reassessed and there was no chordee. Once we were sure that the chordee is fully corrected, we tied off the sutures and checked chordee again- Chordee was completely corrected by these plication sutures. Buck’s fascia was closed on either side with 6-0 PDS. Circumcision was completed and skin rearranged and closed in 2 layers with 6-0 PDS and 5-0 vicryl rapide. 12Fr silicone catheter was placed per urethra anddressing was done. Catheter was removed after 7 days. At follow up at 6 months after surgery, there was no chordee and the erection was straight.

Severe ventral chordee in adults: Diagnosis and management

Chordee is characterised by the curvature of the penis, which is noticeable only during penile erection. While chordee can occur in adulthood due to Peyronie’s disease, most of the cases of chordee are present from birth (congenital). Chordee can be missed in childhood, especially if there is no hypospadias. In such cases, men present with challenges in adulthood,d such as pain during erection, difficulty in sexual intercourse and some men can also have psychological implications impacting self-esteem.

In chordee, there is a noticeable bend in the penis during an erection, which can be downward, upward or sideways. The most common chordee type is ventral chordee, where the penis bends downwards, as in the present case. Surgical correction is the only effective method of chordee correction in adults. The goal of the chordee correction surgery is to straighten the penis and restore normal function. Chordee correction can be done by dorsal plication or a ventral lengthening procedure. The ventral lengthening procedure is done if there is a short urethra,  which contributes to the penile curvature. If the urethra is normal with good penile length, then dorsal plications are preferred.

In the above-mentioned case, the penile length was good, and the urethra was normal, hence we proceeded with dorsal plication. In this procedur,e multiple (16 or 24) non-absorbable fine sutures are strategically placed on the convex side of the penis. These sutures are placed in pairs and in a parallel fashion to create plications in the tunica albuginea. Neurovascular bundles are carefully raised and saved from any injury before placing the plication sutures.

Important note for adult chordee

It is essential for adults considering chordee correction to have a thorough evaluation by a hypospadias specialist who specializes in penile reconstructive surgery. The surgeon will

Assess the type and degree of curvature, discuss the case and recommend the most appropriate surgical technique whether plication or a staged procedure. At hypospadias foundation, we get adults and children from all over the world in search of treatment for hypospadias and chordee. We provide support and information for children, adults and their families affected by hypospadias. Dr A K Singal is a highly experienced surgeon and regarded as the best hypospadias surgeon in India and in the world. He has dedicated his life towards treating children and adults with hypospadias. His expertise in this area has helped us achieve excellent outcomes in adults and children with hypospadias.

Dr Ashwitha Shenoy is an expert pediatric surgeon with special interest in pediatric urology and hypospadias. Dr Singal and Dr Shenoy are deeply devoted to creating awareness and helping patients get the right treatment for hypospadias be it primary, redo or adult hypospadias. Children and adults from more than 25 countries visit our hypospadias foundation in search for cure and are cured of hypospadias. Both Dr Singal and Dr Shenoy work together to give best results for hypospadias surgery in India for both children and adults.

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/

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.

Watch Video of Distal Penile Hypospadias Surgery by Dr A.K.Singal, Best Hypospadias Surgeon In India.

As doctors we are blessed to earn both money and gratitude from our patients. This is even better for us Pediatric urologists as we can experience deep happiness of the parents when their little one gets better after a surgery. We personally feel that we are a part of their life now as we were the lucky one’s to be there when they were struggling to get their little one through a difficult time such as surgery. God has given such unique position to doctors caring for kids as they can then see kids growing up year by year and feel blessed to have invested their life into building up a healthy and safe future.

The diagnosis of hypospadias in a newborn baby can cause a lot of anxiety, distress and pain to the mother who has just delivered, the husband who hasn’t slept in days and the family which has keenly waited for 9 months. At this time in first few days of life, if a proper counseling and guidance can be given by an expert, it can make a world of difference. This may not be possible all of the times as surgeons caring for children with hypospadias on a very dedicated basis are far and few in between across India. Most of the pediatric urologists and surgeons are adept in diagnosing, understanding and counseling for hypospadias and hence should be called in neonatal age itself.

One year back, I received a call from neonatal nursery to see a newborn baby born with hypospadias. Both mom and dad were doctors and worked in Chennai, Tamilnadu, India. Mother was delivering in a Navi Mumbai hospital as the maternal side family lived in Vashi. During the visit, I could see the anxiety and concern writ large on her face. She was torn between playing her role as a mother and her knowledge as a doctor. I discussed with her in detail about the type of hypospadias and also the corrective surgery needed. Since it was a midpenile hypospadias, I told them that a single stage urethroplasty repair was possible. We discussed at length about the right age for surgery and anesthesia. The baby and mother were discharged from nursery at 3 days and then I saw them again at 1 month of age, By this time, the mom was mentally tough and ready for the surgery. We planned the surgery at 6 months of age.

The family travelled from Chennai to Navi Mumbai at 6 months of age with a preplanned date for surgery. Since the urethra was hypoplastic for a short distance proximally and the urethral plate was not very good, we did an onlay island flap repair. The surgery was completed in 2 hours and A.J. was discharged the next morning. The hypospadias dressing was removed on day 5 and the urinary catheter was removed on day 10 after surgery. A.J. healed well over next 2 weeks and the family visited me again 6 months after surgery. A.J. is passing urine from tip of penis, the penis is straight and there is an excellent cosmetic result of his hypospadias surgery. The family is overjoyed and I am also relieved and happy with the good outcome.

The mother sent us a nice thank you note last week and it made my day. It follows verbatim here:

Hello Dr. Arbinder Singal,
A happy parent with a blessed son.
First I would like to convey my heartily thankfulness for your key role in my life. I would rather tell it as my life because my son is my life.
October 2012, good news was accompanied with sad news too, when my pediatrician told me that my son is suffering from hypospadias. Even though I am also a doctor, a fearful alarm rang inside a mother with loads and loads of questions.
But to my rescue doctor, your opinion was asked. During your visit, you were polite and calmly answered all my questions and relieved my fears.
As I am from Chennai and my parents stay in Chennai, everything fell in place very conveniently.
After 6 months, the day for hypospadias surgery came, as doctors, my husband and I were ready mentally but emotionally it was a nightmare.
But thank you doctor, MITR doctors and staffs- All made us feel very comfortable. You were so supportive and took care of everything right from the beginning.

That day gave a new life to my son. Now he is doing fine and leading a happy and normal life.

Six months have passed and everything is well.

Thank you God
Thank you doctor
Thank you MITR Hospital and staff
Thank you Hypospadias foundation
May your sincere service continue forever for the needy.
God bless you
Yours
A happy parent with a blessed son

Footnote:

These are the letters and emails which make caring for kids worthwhile even in the face of all risks and uncertainties of surgery on a small child. In the dark times, these blessings shine like rays of hope and give energy to carry on. I wish to express gratitude to all parents who have trusted us with the care of their little ones. We feel truly blessed and honoured to be of help.

About the author:

Dr A.K.Singal is a Pediatric Urologist and a specialist hypospadias surgeon. He does more than 200 hypospadias repair surgeries every year and has the best results for complicated and failed hypospadias. Every year he gets referred complex, severe and failed hypospadias patients from all over India and more than 20 countries. Along with the team at Hypospadias Foundation and MITR Hospitals, he feels joy and blessings in caring for children with hypospadias.

Hypospadias is the most common urological anomaly (birth defect) seen in newborn babies worldwide. It is mostly diagnosed soon after the baby is born when the opening of for urine is seen to be on underside of penis, the foreskin (prepuce) is incomplete on the underside and there may be a bend in the penis (chordee). Very rarely, if the hypospadias is very mild, it can be missed on neonatal examination by even a pediatrician.

Lot of countries and religions practice and advocate newborn circumcision in all male babies but whenever hypospadias is diagnosed in newborn age, circumcision should not be done. During circumcision, the prepuce is cut off and a very vital tissue which is required for hypospadias repair surgery is lost. Prepuce or its layers are used for anatomical hypospadias correction surgery. In a circumcised boy, hypospadias repair becomes difficult and complication rate of hypospadias surgery is little higher.

Master K.Hadriel.Ileunga was born in Congo (Africa) in a small city. His doctor did not recognize at birth that he had a distal penile hypospadias. He underwent a circumcision in the first few days of life by a general practitioner doctor. Later his parents and doctors realized that Hadriel had a distal penile hypospadias. As he grew up in Congo (Africa) his parents worried about his hypospadias. They visited a few doctors in Congo but there was no pediatric urologist available in Congo who could do a hypospadias repair after circumcision. At this time, they learnt about Hypospadias Foundation in Navi Mumbai, India and sent an email to come and get treated under Dr A.K.Singal’s care, one of the most renowned pediatric urologists and the best Hypospadias Surgeon in India.

Finally in first week of Jan 2015, the family met Dr Singal in Navi Mumbai. On examination, Hadriel had a distal penile hypospadias without chordee. There was no prepuce as he had undergone a circumcision in newborn age. After discussing with the parents, Hadriel was taken up for Hypospadias repair surgery on 16 Jan 2015. The surgery was done using Tubularised incised plate urethroplasty – also called Snodgrass urethroplasty. The whole urethroplasty was completed in one stage. The child was discharged from hospital the next day and the hypospadias dressing was removed after 5 days. The urethral catheter was removed after one week of surgery. Hadriel passed urine in very good stream without any difficulty. After a final follow-up two week after surgery, Hadriel has gone back to Africa- his country Congo and family is very happy. Fortunately, he had an excellent result of hypospadias repair surgery even after a neonatal circumcision.

Hypospadias remains one of the most common urological anomalies across the globe affecting almost 1/150 newborn boys. No nation or economic status or religion is exempt from its occurrence. The art and science of hypospadias treatment has evolved significantly in the last two years with a single stage repair of hypospadias a real possibility in most of the cases. The results of hypospadias surgery are of course better at centres where there are specialist hypospadias surgeons doing dedicated hypospadias treatment in large numbers every year. Even the complications of hypospadias surgeries decrease significantly with increasing experience. This was the aim with which we started Hypospadias Foundation in 2008. Now 6 years later, we are happy to provide excellent outcomes and give happiness to kids and families who travel to India from all over the world.

The Child from Great Britain

Master Narain was noted to have hypospadias as soon as he was born in England. The pediatrician advised the family to meet the pediatric surgeon or pediatric urologist when the child was three months old. Through the NHS system, the family went and met a Pediatric Surgeon who advised hypospadias repair surgery after 1.5-2 years of age.

Mother and father, both UK residents, were worried about delaying the surgery so much as somehow they felt that once the surgery is needed they better get it done at a younger age than a later age. They just couldn’t understand the point of waiting for the surgery which would anyway be required. With this dilemma about the age for hypospadias surgery, they contacted us at Hypospadias Foundation. After a few tele and online consultations they decided to travel to India for Hypospadias repair surgery with us at MITR Hospital in Navi Mumbai, India. We advised surgery between 6 months to one year of age. Finally, when Narain was 9 months old they traveled to India from England and visited us.

On examination, Narain had a distal penile hypospadias without any chordee. The urethral plate was pink and healthy and he seemed suitable for a single stage Hypospadias repair. Parents did not have too many questions and I was very surprised. When I asked, they said that they have read a lot of blogs written by me on hypospadias treatment and were upto date with what their son is going to go through. This was a very happy consultation indeed. Saved me time and energy but still I went through the pre and post hypospadias surgery routine with them explaining to them. They just nodded their heads and posted Narain for surgery one day later and meanwhile we got the blood/ urine tests and pre surgery fitness for anesthesia.

Surgery was done as first case in the morning the following day. Surgery was done under caudal analgesia and sevoflurane anesthesia. Since the urethral plate was good and the hypospadias was not very severe (distal penile hypospadias), we did a Tubularised incised plate urethroplasty also called Snodgrass repair urethroplasty. The surgery took only 75 minutes. Narain tolerated the procedure well and was to his usual playful self in a few hours after surgery. We sent him home by the next morning on usual oral medications for pain and bladder spasms and a mild antibiotic. One week later, the family visited us again in the outpatient clinic for removal of dressing and catheter. Narain passed urine well without any issues and had a good healing operative site at the time of hypospadias dressing removal. Another followup was scheduled at 10 days after catheter & dressing removal. Narain was passing urine in a good straight stream without any difficulty. Also the cosmetic result was excellent. The family was overjoyed and was able to travel back to England within three weeks of surgery. We requested the family to send us a short video of Narain passing urine and a few pictures of his penis at about 6 weeks and 3 months after surgery to confirm that everything has healed without any complication. We received these videos and pictures a week back and were happy to note that there was no complication of the surgery. We expect Narain to do very well and live a normal life after the hypospadias surgery.

About the author:

Dr A.K.Singal is a renowned Pediatric urologist and is considered one of the best hypospadias surgeons in India. He treats more than 100 kids with hypospadias every year at various hospitals in Navi Mumbai, Thane and Mumbai. Lot of kids travel from neighbouring cities such as Pune, Ahmedabad, Surat, Goa and as far as Bangalore, Hyderabad, Calcutta, Delhi, Jaipur, Chennai etc.

He can be contacted by filling up the form here: Contact form Dr A.K.Singal

Hello Dr A.K.Singal,

My feedback from my baby’s operation at Hypospadias Foundation & MITR hospital in Navi Mumbai, Kharghar, sector 21:

When I was told by  my baby’s doctor at the time of birth that he had hypospadias, we were very worried about it as it was the first time I had heard such case. Then I started searching about treatment and could not find any specialist locally in Afghanistan. Then we searched for a hypospadias specialist in India and could find the best pediatric urologist surgeon in Mumbai called Dr. A. K Singal in MITR hospital in Navi Mumbai although, I searched in Delhi and other states. Indeed what all I found it was just from Google net and I was really not sure what is going to be happen. Many questions arose into my mind that how the operation is going to be done? How many days my son would be admitted? And many other questions were there.

Eventually, I got appointment with the MITR hospital via email with Mrs. Emily Paul who was very helpful and then we decided to go India for the treatment and finally reached the mentioned hospital on the 1^st December, 2014. In the same day, Dr. A. K Singal visited my child and he impressed me when he talked about the operation and we decided to operate him after two days. Then on the 3^rd December my baby’s operation was done.
The operation was done in a very professional way and successfully with no issue. Then I realized that I took a really right decision and found the right hypospadias doctor. It was amazing that in the same day my baby did not have any pain and discharged from the hospital but I requested to remain for some more days for betterment of the child. 

We (me and my wife) have very good memories from the Hypospadias Foundation and MITR Hospital especially from Dr A.K.Singal and now we know why he is a renowned Pediatric urologist and one of the best Hypospadias surgeons in India. The staff of Hypospadias Foundation based in MITR Hospital is good and the nurses were really outstanding. I thank them too.

My little angel is doing very well after surgery with no issue and we overcome those all tensions and worries which we had in the past. I really appreciate Dr. A. K Singal and whole MITR team with professional communication and cooperation and your friendly environment.

Considering that our son had hypospadias which can have lot of stigma, we request you to keep his name and identity confidential. We would be happy to interact with parents whose children are suffering from hypospadias any time offline.

Thank you Dr. Singal.

Best Regards,

Mr M.H., Herat, Afghanistan

Case description:

Master F.H.,8 months old child underwent distal penile Hypospadias treatment at our hospital recently (Dec 2014). Father had written to us about a month back expressing a desire to travel for Afghanistan to India for the hypospadias repair surgery. They had sent us pictures of the penis via email and we could explain to them the type of anomaly and the surgery needed for the same. Fortunately, the father took very good and clear pictures as instructed and it was easy for us to understand even without examining the child. Ms Emily Paul and Dr Rajkumar coordinated the OPD appointments and then one fine day the baby was at our hospital in Navi Mumbai. We confirmed the hypospadias to be distal penile hypospadias and did the pre surgery checkup and fitness by a Pediatrician. We took up the baby for surgery on 03/12/2014 and surgery was done using Tubularised Incised plate urethroplasty (TIP repair) also called Snodgrass repair or Snodgrass urethroplasty. Originally described by Dr Warren Snodgrass, the TIP repair is one of the most reliable and common repairs done worldwide for distal and midpenile hypospadias in selected and suitable cases.

The surgery was finished in one hour and F.H. was allowed feeds after 3 hours of surgery. He was at his playful best by evening and we planned to discharge the baby. Parents were very worried about taking him to a hotel and requested to stay in the hospital for another week till the dressing and the catheter were taken out. In normal circumstances, we discharge most of the hypospadias surgery kids by evening of surgery but here understanding the situation we allowed them to stay for a week. Finally the catheter and the dressing were removed in 5 days and the parents took the child to Pune with them. I saw them on 15^th Dec 2014 once again before their final flight back home to Afghanistan from Delhi. He was doing very well and the penis had healed very nice with good cosmetic and functional outcome.

Staff and nurses were very fond of master F.H. as he was a very happy baby and used to come to everyone’s arms easily and used to play with them. He used to be in my lap all the time. All of us here at MITR Hospital and Hypospadias Foundation wish him the very best in life. And we all miss him.

About the Hypospadias Foundation & Dr A.K.Singal

Hypospadias Foundation in Navi Mumbai, India is the world’s only organisation committed and dedicated to treatment and care of children having hypospadias. Over last 6 years children from all over India and from more than 15 countries have benefitted from care at Hypospadias Foundation.

Dr A.K.Singal, Pediatric Urologist and Hypospadias Surgeon is an expert and renowned surgeon for management of children and adults with Hypospadias. Dr Singal and Dr Manish Dubey are close friends and together started Hypospadias Foundation in Nov 2008.

Dr Singal can be contacted by filling up this form: Enquiry form for Hypospadias

Or you can call up Dr Rajkumar (Dr Singal’s assistant) at +919821261448

His clinic timings in Navi Mumbai, Thane and Mumbai are available here:

Clinics and Timings for Dr Singal

Hypospadias repair surgery videos by Dr A.K.Singal: