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 30th October 2019-1st 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 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.

Letter from Australia makes our day and life worthwhile: Infant with scrotal hypospadias gets operated successfully in one stage in India

Hypospadias is a common urological anomaly and fortunately most of the hypospadias are distal or midpenile in variety with good results in one stage surgery. Scrotal hypospadias are the most severe forms of hypospadias where the opening in far behind in scrotum, in between the testicles. 6 months back we treated a child with hypospadias who travelled with his family all the way from Australia for a hypospadias repair surgery. But the story actually started as soon as the baby was born. The family had contacted us for an email and telephonic consultation and we were there with them from the neonatal age till the surgery and the care continues electronically even now.

Fortunately, with meticulous pre-surgery planning and good support we could get a good result of the surgery in one stage itself. The child is doing very well now and doesn’t look like that he will need any further hypospadias surgery. The family was overjoyed and they have sent us an email now (6 months after surgery) and we were all very happy to read the email. It made our day and also made the whole purpose of starting Hypospadias Foundation worthwhile.

We have taken the liberty of using most of the email in an unedited format here after seeking due permission from the family.

Hi Dr. Arbinder Singal,

How are you?

Please find below what we truly felt. Also as discussed, we would not prefer either our or or son’s name to be reflected in the recommendation, however please feel free to provide my details to parents who are in a similar situation and need help just like we did when our son was diagnosed with severe hypospadias.

 First News

 It all started on 2nd December when my son was born in Sydney (Australia), it was the happiest moment of my life but I didn’t know that it will last only for the next 24 hours. 

The next morning, as a usual process in Australian Hospitals, Specialists came to check my son and called me. The specialist checked my son and without any emotions or sympathy or even empathy told me that my son is suffering from Hypospadias and that too a severe one and it will take at least 2-3 operations period. My ears were striving hard to hear that after those operations it will be completely cured and everything will be fine but the doctor told me that the Hypospadias is severe and there is no guarantee and gave me an information booklet with scary after operation images. As far as I remember I asked him thrice may be more that whether my son would be alright after those operations? yearning for an answer that “everything will be alright” may be a pat on my shoulder to give me some strength or courage to deal with the situation but he left without saying even a single positive word. 

I could barely walk after that conversation, everything around was meaningless and sad. My wife was still in the hospital recovering from the caesarean operation, I chose not to tell anyone in my family and let them be happy.  I came home that night as you are not allowed to stay in the hospital in Australia. I was not able to sleep that night and the next morning while I was still at home, all my emotions came out, I couldn’t stop the tears and my family came to know about it and tried to give suggestions but that doctor had filled my whole system with so much negativity that I believed that there is no solution and my son will never be cured. After venting out my emotions, I started researching about Hypospadias specialists in the world and I found Dr V.R.Jayanthi and called his clinic in U.S.A but he was not available. I did some more research and found Hypospadias foundation in Navi Mumbai, India. Honestly I didn’t care to read the content on the site  and went directly to the contact us page as I was so desperate to talk to a specialist and got through Dr. A.K. Singal’s clinic and fortunately they helped me to set up an telephonic appointment with him. 

Half an hour Conversation changed everything!

Carrying a huge backlog of negativity, I called up Dr. Arbinder Singal. The conversation started with a lot of questions and Dr. Arbinder Singal listened to all my questions and concerns patiently and irrespective how silly the questions were, he answered to every question in detail. Honestly that conversation changed my life and in particularly one sentence from him – “THERE IS NO HYPOSPADIAS WHICH CANNOT BE CURED”. He guided me to contact a pediatric endocrinologist right away and explained in detail on how to proceed with the next steps. I recorded that conversation and told my wife about the news because now I had the solution – Dr. Arbinder Singal!

A Close shave

I am really thankful to Dr. Arbinder Singal for recommending a pediatric endocrinologist at that point. I want to again emphasize here that everyone apart from Dr. Arbinder Singal missed an important step in the journey – Meeting a Pediatric Endocrinologist.  

As per the paediatric endocrinologist – Dr. Andrew Biggin (he is still my son’s paediatrician and has agreed to mention his name) there were some injections which needed to be given to my son before a certain age which we would have definitely missed as no other Doctor asked us to meet a paediatric endocrinologist.  We communicated a lot with Dr. Arbinder Singal updating him about the progress and again asking questions to which he patiently responded every time. He also helped us to get in touch with the other parents whose children had undergone hypospadias repair surgery under his care which helped a lot as they explained us how they went through the treatment and journey. We are really thankful to those parents as well as every time we had an emotional breakdown or we felt nervous they acted as a big emotional support and had long conversations calming us down. Finally Dr. Arbinder Singal helped us decide a date and hospital for hypospadias operation.

The Surgery..

We travelled to India for surgery and we arranged a villa near Fortis Hospital in Vashi, Navi Mumbai and went to meet Dr. Arbinder Singal for the first time in Mumbai. After our meeting the comfort level and confidence increased multi-fold, he was very nice to speak with and inculcated the same confidence in us. He checked my son and said he will try to do it in one operation itself. We had already booked a room in Fortis and admitted my son for the surgery. We met him again before the hypospadias operation, we were nervous but we were calm as we knew that our son was in safe hands. All the hospital staff was very helpful on the operation day and Dr. Arbinder Singal gave us the good news that the operation is successful and my son would not need another surgery.

Highly Highly Recommended!

I would highly recommend Dr. Arbinder Singal as he is an hypospadias expert and good human being. He is reachable and understands the emotions & nervousness which the parents go through. All the more the issue which all the doctors in Australia could solve only by doing multiple hypospadias surgeries, he did that in one go with a single stage hypospadias repair.

I and my family are and would be really thankful to him for forever.

Thanks Dr. Arbinder Singal & Hypospadias Foundation!!

Regards,

A happy kid and his family

Sydney, Australia

 

About Hypospadias Foundation and Dr A.K.Singal

Hypospadias Foundation is an organisation dedicated to care & cure for patients children and adults suffering from Hypospadias and DSD (disorders of sex development). It is located within a boutique Urology centre – MITR Hospital in Kharghar, Navi Mumbai, India (www.mitrhospital.com ). Hypospadias Foundation was started in 2009 by Dr A.K.Singal and Dr Manish Dubey and till date more than 800 children and adults have been treated at the Foundation from all over India and more than 20 countries (june 2015). The foundation keeps on growing with blessings from families and support from society.

Dr A.K.Singal is a renowned pediatric urologist surgeon and a top hypospadias specialist practicing in Mumbai, India. He is an expert in management of children and adults with hypospadias and is a strong force behind community and medical education for hypospadias. Every year he does more than 200 surgeries for hypospadias and conducts research for hypospadias. For his deep passion and excellent results in hypospadias, Dr Singal is counted as one of the best hypospadias surgeon’s in the world.

Hypospadias Foundation can be reached at hypospadiasfoundationindia@gmail.com or you can call Dr Rajkumar (Coordinator) at +919821261448

Or you can fill up this contact form: Contact Hypospadias Foundation

Watch Video of Scrotal Hypospadias Surgery by Dr A.K.Singal

Watch video of proximal penile hypospadias repair surgery by Dr A.K.Singal

Watch video of distal penile hypospadias operation surgery by Dr A.K.Singal

Cashless or Mediclaim Coverage of Hypospadias repair surgery and treatment by Insurance Companies in India

Hypospadias is a urinary birth defect in which the urinary opening is on the underside of penis rather than being at the tip of the penis. In more than 50% of patients with hypospadias, the penis is also bent downwards – this penis curvature is called chordee. Hypospadias affects 1/150 newborn boys and hence more than 1 lakh (1,00,000) kids are born in India with hypospadias every year. Worldwide the incidence has increased probably due to increasing burden of chemicals and pollutants which act as endocrine disruptors (chemicals which block male hormone action) and have contributed to an increasing incidence of hypospadias.

Most of these kids except the ones with very minor glanular hypospadias without chordee will need surgery. The surgery is ideally done between 6months-18 months for age of the child was born with good weight and full pregnancy, if the child is underweight or preterm or has any other major anomalies then it may be better to wait till the child is about 3 years of age.

When and how does hypospadias happen?

Hypospadias results from defective formation of urinary tube during 8-12 weeks of pregnancy and hence if there is an interference with penis development after 12 weeks of pregnancy, hypospadias cannot happen as penis formation with urinary opening at tip is complete by 12 weeks of pregnancy. Between 8-12 weeks of pregnancy, the urinary pipe forms under the penis from the base to the tip under influence of testosterone and dihydrotestosterone. Along with the urinary tube the various covering layers of the penis such as spongiosum , bucks, dartos and skin also also formed. Hence when the urethra remain short of tip, all surrounding layers also become short.

Is Hypospadias repair surgery covered by insurance companies or corporates for cashless treatment or re-imbursement?

Hypospadias being a penis birth defect is classified as an external birth defect which can be easily diagnosed as soon as the baby is born. Hence, if parents take an insurance policy after the baby is born, hypospadias surgery treatment costs are not covered by most of the insurance companies in India atleast while in USA, UK it is covered under insurance benefits.

The situation is different for some of the corporate insurance group policy holders. Some big corporates like TCS, Reliance, L & T, Siemens etc issue very employee friendly mediclaim policies which cover all medical and surgical treatments for the employees and their families. Such mediclaim policies cover all pre-existing as well as birth defects for their employees and hence hypospadias repair procedure may be covered by the insurance company by some of these companies.

If insurance does not cover the hypospadias treatment, how much does it cost for Hypspadias repair surgery?

If the insurance company is not covering the treatment, then the parents will have to pay the full charges themselves out of their own pocket. For new parents working in a job or middle class environment this may be financially stressful. What really helps is that Hypospadias repair surgery is a planned procedure. It can be done anytime between 6 months-15 months of age giving parents enough time to rally around and arrange everything from money to other resources. The cost of hypospadias repair surgery depends on the type of hypospadias, complexity of repair, which hospital as well as which type of room one chooses to stay in hospital. On a ball park figure it may wary from 75000 Indian rupees for a minor hypospadias surgery in Hypospadias Foundation to even 3,00,000 Rupees for a complex severe hypospadias surgery in a single deluxe room. Hence, it is best that they meet a hypospadias expert or a pediatric urologist early on in first 3 months of baby’s life and then learn everything about the cost of hypospadias surgery, hospital stay, pre-hypospadias surgery tests and then get mentally prepared for the actual surgery.

About Hypospadias Foundation, Navi Mumbai, India

Hypospadias Foundation is an organisation started by Dr A.K.Singal and Dr Manish Dubey for caring, education and research in field of Hypospadias. Dr Singal is one of the best Hypsoapdias Surgeons in India. The team operates more than 200 children and adults every year with best results in hypospadias treatment. The Foundation operates as a part and parcel of MITR Hospital in Kharghar area of Navi Mumbai. MITR Hospital has cashless and mediclaim tie-ups with all major insurance companies and TPA’s to facilitate cashless treatment of hypospadias if the insurance policy covers it.

If you or your child has hypospadias and need to know more, please write to us at hypospadiasfoundationindia@gmail.com or fill up this contact form

Contact form for Hypospadias Foundation

Watch Videos on Hypospadias Channel by Dr A.K.Singal

Video of Distal penile hypospadias repair surgery

Video of Proximal penile hypospadias surgery

Video of Scrotal hypospadias repair

Successful result in a failed hypospadias repair: Boy from Gandhinagar (Gujarat) visits Hypospadias Foundation for a follow-up 5 years after surgery

Hypospadias remains the most common urological abnormality affecting more than 1 lakh kids in India alone (based on incidence of 1/150 in newborn boys). Leaving aside very minor hypospadias without chordee- almost 70-80% of these require hypospadias treatment in form of repair surgery in early childhood.

For a child with Hypospadias, the first surgery is always the best surgery but still there can be complications and failure even in expert hands though complications are much less if operated by a surgeon or a centre where there is a focused practice in treating children with hypospadias. Literature and experts suggest that if a hypospadias surgeon is doing more than 50 hypospadias repairs in a year, then his results will be better and more predictable as compared to a general pediatric surgeon or a urologist who does only 10-20 hypospadias repairs in a year. Once a hypospadias surgery fails, then the next surgeries become more difficult and result more unpredictable. The failure rate of hypospadias surgeries vary from 5% to 50% depending on the type and severity of hypospadias in general centres and less than 10% in centres where hypospadias surgeries are done by expert hypospadias surgeons on a day to day basis.

Case details

Master A.P. was born with a distal penile hypospadias and underwent first surgery in Ahmedabad at the age of 6 years. Unfortunately, the surgery failed and he started passing urine from the same place on the underside of penis- a fistula. The new urinary passage through the head of the penis got tight and closed off. The surgeon tried to open it many times by catheter insertion but it failed. Coupled with failed hypospadias, the child also had an unsatisfactory cosmetic appearance in form of bunching of skin on underside of penis. With this situation they contacted Dr A.K.Singal, Pediatric urologist and expert Hypospadias surgeon at Hypospadias foundation in Kharghar, Navi Mumbai when the boy was ten years of age. After examining and confirming that the whole urinary pipe will have to be remade from distal penile region to the tip of penis (glans), Dr Singal advised a Onlay island flap repair for which the flap would be raised from the nearby bunched up skin. This repair is technically challenging because of previous failed hypospadias surgery but this was the only chance for the boy to have a single stage repair. The surgery for failed hypospadias was finished in 2 hours and A.P. was ready for discharge the next day but since they had travelled all the way from Gujarat, they decided to stay for 7-8 days in Navi Mumbai. The catheter was removed on day7 and he passed urine well from the tip. For the first one month after surgery, there were some chances of new opening getting tight, hence we taught the boy to insert a small catheter just 1cm into the new opening with an antibiotic ointment. The penis healed well in next 3 months and he has remained free of all symptoms now for last 5 years. At 15 years of age and after his 10th standard exams, A.P visited us and had a big smile on his face. He is looking forward to higher education and he shared with us his dreams and further education goals. We plan to see him again one last time at 18 years of age. His penis growth and his functional & cosmetic outcome has been excellent so far.

Dr A.K.Singal with the patient

Letter of thanks from the father:

Dear Dr Singal,

My son A.P was operated first at Ahmedabad. The hypospadias problem was not solved and it actually worsened and we were very tense my son’s future life. While searching through internet I came to know about you and your colleague doctors.

From your past surgeries and mastery about Hypospadia surgeries we decided and contacted you before surgery. At Mitr hospital, from the first meeting with you, we were confident about our son’s second Hypospadias surgery and we decided to do it only with you.

At Mitr Hospital, we experienced very good pre and after surgery treatment from Doctors and staff also, very good and polite staff. At Gujarat we don’t have such experienced and professional hospital staff. I think this is also very important besides doctors. I feel that if the doctors are not confident they must not try and go ahead for these type of surgeries because once it is fails, the situation of patient and his family is unbearable. It creates psychological problems also and these can be very stressful to handle. Thanks to your team, my son is doing well now.

Regards

M.P., Gandhinagar, Gujarat.

About Failed Hypospadias repair:

When the hypospadias surgery fails, it is a moment of distress and lot of anguish for the parents. Even the doctors feel terrible because they know that even a hypospadias surgery which has been done well doesn’t mean that everything will heal also well. There are many variable factors which affect healing and hence, complications of hypospadias surgery happen sometimes even in best of hypospadias surgeon’s hands. The only difference being that when an expert hypospadias surgeon does the surgery, the chances of complications decreases drastically. And even if the complications happen, they can be managed well without any panic or long lasting impact.

The complications which may need second surgery are: urethral fistula, tight urethra (stenosis or urethral stricture), residual curvature (chordee), dehiscence (complete breakdown or partial breakdown), diverticulum, penile torsion or an unsatisfactory cosmetic outcome. Once it is ascertained that a second surgery is indeed needed for hypospadias, it is important to wait for 5-6 months before planning the next surgery.

About Dr A.K.Singal

Dr A.K.Singal is a well known Pediatric Urologist and one of the best hypospadias surgeons in India. Every year under his care in Mumbai, Thane and Navi Mumbai, more than 150 children undergo hypospadias treatment. More than 50 of these are children who have failed hypospadias surgery done elsewhere. With his deep understanding and experience, Dr Singal and his team are able to offer care and cure to these children. He can be contacted at hypospadiasfoundationindia@gmail.com or you can call his Assistant Doctor – Dr Rajkumar at 98212161448 if you wish to take a second opinion for a failed hypospadias surgery. Else you can fill up this contact form:

Contact Dr A.K.Singal