A closer look at severe chordee correction in an adult by 24 dot plication

25-year-old adult presented to the Hypospadias Foundation OPD with complaints of severe curvature of the penis. There were no urinary complaints. He also that the curvature has worsened over time. On examination, there was severe ventral curvature (downward bending) of the penis. 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 surgery. Surgery was planned in single or two stage depending on the degree of curvature and the ventral urethral calibre. 

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Picture 1: Severe curvature of the penis noted on erection

Picture 2: Pre-operative assessment showed normal location of the meatus. Second image shows marking for degloving

Surgery was started by taking a stay stitch on the glans with 4-0 prolene. Marking of the 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 plication procedure 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. Chordee was reassessed and there was no chordee. 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 and dressing was done. Catheter was removed after 7 days. Follow up at 6 months after surgery, there was no chordee and the erection was straight. 

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Picture 3: Complete degloving done and artificial erection test done which showed more than 60-degree chordee.

Picture 4: Neurovascular bundle raised on both sides upto the midline. Marking done, plications sutures placed, held and artificial erection test done. No chordee noted

Picture 5: 24 dot plication completed and circumcision done

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Picture 6: Penile  erection straight 6 months after surgery

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Picture 7: Cosmetic result 6 months after surgery

Severe ventral chordee in adults: Diagnosis and management

Chordee is characterized by curvature of the penis which is noticeable only during penile erection. This is congenital (present at birth) but can be missed in childhood and can present with challenges in adulthood potentially causing discomfort, affecting sexual function and can also have psychological implications impacting self-esteem.

In chordee, there is noticeable bend in the penis during an erection which can be downward, upward or sideways. It can cause pain or discomfort during erection or sexual intercourse. Surgical correction is the only effective method of chordee correction in adults. The goal of the surgery is to straighten the penis and restore normal function. Chordee correction can be done by dorsal plication or ventral lengthening procedure. Ventral lengthening procedure is done if there is 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 procedure 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 parallel fashion to create plications in the tunica albuginea. Neurovascular bundles are carefully raised 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 specialized 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. We provide support and information for children, adults and their families affected by 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. 

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. Both Dr Singal and Dr Shenoy work together to give

Two stage repair of deceptive distal penile hypospadias with hypoplastic urethra and severe chordee

6-year male from Kerala presented to the Hypospadias Foundation clinic with complaints of passing urine from distal penile region associated with downward curvature of the penis (chordee). On examination, meatus was in distal penile region, but the urethra was thin till the proximal penile region. The stretched penile length (SPL) was 40mm and glans diameter (GD) was 12.5mm. In view of small glans diameter, he received two doses of injection testosterone in the pre surgery period which were given 1 month apart. Following the two doses, the stretched penile length improved to 35mm and glans diameter to 15mm.

He was planned for hypospadias repair and the family was counselled for single or two stage repair based on the degree of chordee.

The surgery was started by complete degloving which means the penile skin was completely taken down preserving its blood supply. After degloving, the chordee was assessed by artificial erection test. Here in this case after complete degloving, artificial erection test showed chordee of more than 45 degrees. This was because of the hypoplastic (underdeveloped) tissues on the underside of the penis. We decided to divide the urethral plate and mobilise the urethra. Spongiosum was raised on the sides first, urethral plate divided at coronal level and urethra mobilised till penoscrotal junction to fully evaluate the chordee. Chordee was reassessed and there was persistent chordee of more than 45 degrees. Site of maximum curvature was marked on the ventral side (underside of the penis) and three corporotomies were made by placing horizontal incisions over the tunica with middle incision at the site of maximum curvature. Chordee was reassessed and there was still significant chordee necessitating a ventral penile lengthening procedure called as dermal graft. The central corporotomy incision was deepened to full divide tunica and then cavernosal tissue was mobilised from tunica on all sides. A skin ellipse was harvested from the inguinal region, de-epithelized, and defatted to create a dermal graft. This dermal graft was sutured at the site of tunical defect with 6-0 PDS interrupted sutures. An artificial erection test following dermal graft revealed no chordee.

Once the chordee was corrected, the proximal urethra was sutured in the proximal penile region with 6-0 PDS. Glans wings were raised. Byars flap was created. Byars flap involves division of the dorsal prepuce in the midline and then rotation to the underside of the penis to cover the whole underside of the penis from glans till all around the meatus.

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Picture 1: On clinical examination, the meatus was in the distal penile region with thin urethra till the proximal penile region. Surgery was started by complete degloving

Picture 2: Artificial erection test showed chordee of more than 45 degrees

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Picture 3: Urethral plate divided, mobilised and chordee reassessed. More than 45 degrees chordee noted

Picture 4: Three ventral corporotomies given and chordee reassessed, persistent chordee of more than 30 degrees noted, hence planned to go ahead with ventral lengthening procedure

Picture 5: Deep corporotomy given at the site of maximum curvature and tunica incised, dermal graft harvested from the right inguinal region

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Picture 6: Dermal graft sutured at the site of tunical defect. No chordee noted after dermal graft.

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Picture 7: Dorsal prepuce (foreskin) divided in the midline and flaps rotated to cover the underside of the penis

Second stage of Hypospadias Repair:

After 6 months of first hypospadias surgery, the child was taken up for second stage urethroplasty. We checked chordee again before starting the urethroplasty (urethral reconstruction) and the penis was completely straight. The prepucial flaps which were done in first stage had healed very well. The flaps were wide and supple. 15mm wide incision was marked on the flaps and, local anaesthesia was infiltrated at the marked site and incisions were deepened till the corpora. Urethroplasty was done over 7Fr Infant feeding tube in two layers with 6-0 PDS absorbable sutures. Dartos flap was harvested from both sides and sutured over the entire urethroplasty. Glans wings were raised. Distal urethroplasty and glansplasty was done, and a new meatus was created on the glans. The dressing in the post operative period was changed on post operative day 7 and catheter was removed on post operative day 12. Child was passing urine through the new opening in a good stream.

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Picture 8: Prepucial flaps 6 months after stage 1 were healed very well. Flaps were wide and supple. Artificial erection test done before urethroplasty done showed no residual chordee

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Picture 9: 15mm wide flaps marked and incised.

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Picture 10: Urethroplasty done over 7Fr Infant feeding tube, dartos flap raised and sutured over the urethroplasty and glansplasty done

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Picture 11: Completion of urethroplasty and follow-up at post operative day 12

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Picture 12: Urine stream following catheter removal

Distal penile hypospadias with severe chordee (Deceptive hypospadias)

In some cases of hypospadias, the urethral opening is not only in an abnormal location but also the urethra can be underdeveloped or hypoplastic. Hypoplastic urethra is characterized by thin, underdeveloped, paperlike quality of urethral plate and the existing distal urethra. While the meatal opening may be near the tip, the presence of a hypoplastic or underdeveloped urethra indicates a more complex form of hypospadias, even if the urethral meatus appears relatively distal. This is often associated with chordee which contributes to the overall complexity of the hypospadias.

The hypospadias repair in hypoplastic urethra is more challenging. This thin urethra does not have enough robust tissue to create a new functional urethra. Using this thin urethra in reconstruction can lead to complications such as fistula formation, stricture, diverticulum formation or dehiscence.

The surgical management in hypoplastic urethra often requires specialized techniques. Degloving in these cases must be done carefully because of higher chance of injury to the urethra due to its paper-thin consistency. The type of surgical repair in cases with hypoplastic urethra is decided based on the degree of chordee. If the chordee is not significant and if single stage repair is planned, then either the thin urethra must be laid open before staring the urethral reconstruction or spongiosa around the thin urethra has to be mobilized and sutured over the thin urethra which is called as Spongioplasty.

For severe cases, like in the above-mentioned case with significant chordee and extensive hypoplastic urethra, two stage repair may be necessary. In the first stage, the penis is straightened and prepucial flaps are created. In the second stage which is 6 months after stage 1, the flaps are tubularized to form the new urethra.

Long term follow in cases of hypoplastic urethra is necessary because complications like stricture can develop years after hypospadias repair surgery. Hence these complex cases of hypoplastic urethra with hypospadias should be performed by an experienced hypospadias surgeon.

At hypospadias foundation, we have operated many cases of hypospadias with hypoplastic urethra. Each case is thoroughly examined in the preoperative period, carefully degloved during the surgery, meticulously assessed and hypospadias repair is done considering factors such as degree of chordee, severity of hypoplasia and quality of urethral plate. This has helped us achieve success rate of more than 95% even in the most complex cases.

The team at Hypospadias Foundation has two experienced hypospadias surgeons. Dr A.K Singal is considered the best hypospadias surgeon in India and the world and has a special expertise in managing complex hypospadias cases. His profound anatomical knowledge, meticulous surgical skill and an unwavering commitment to restoring both form and function in hypospadias has transformed various lives.

Dr Ashwitha Shenoy is an expert hypospadias surgeon who along with Dr Singal has dedicated her life to treating children and adults with hypospadias. Their dedication extends beyond the operating room, offering compassionate guidance and hope to families navigating a challenging diagnosis.

Single stage hypospadias repair in a boy after multiple failed hypospadias surgeries

“Mast SP, a 15-year-old male from South Africa, is a case of failed hypospadias repair, having undergone four unsuccessful surgeries elsewhere in the past. Despite previous attempts, the desired result of hypospadias repair was not achieved. He presented to us with complaints of spraying of urine with residual chordee. On clinical examination, we found that the meatus was located at the coronal region. The penis was small with flat glans. He was planned for cystoscopy to assess the status of the native urethra, and redo hypospadias surgery was planned in a single stage or in two stages depending on the cystoscopy findings, addressing the challenges of hypospadias repair in a boy

Hypospadias repair in a boy

1. Clinical picture showing coronal meatus.

Cystoscopy showed normal urethra. Since the majority of the urethra was normal, we planned for single stage repair, focusing on hypospadias repair in a boy. We chose to proceed with single stage distal oral mucosa inlay graft urethroplasty.

Chordee assessment was done at the start of surgery, and the patient did not have chordee, hence degloving was not done. A midline incision was given in the urethral plate to assess the quality of the urethral plate. There was no scarring in the urethral plate. Since the urethral bed was healthy, we planned to place an oral mucosa inlay graft and perform single stage urethroplasty.

Hypospadias repair in a boy
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2 a & b. Clinical picture showing the marking of the incision and chordee assessment.

Oral mucosa graft was harvested from the upper lip to perform hypospadias repair in a boy. The graft was defatted and sutured at the urethral bed using 5-0 vicryl. The graft was sutured at the edges of the urethral plate and was quilted in place using 5-0 vicryl sutures. Following inlay graft placement, glans wings were widely mobilized. Urethroplasty was done using 5-0 vicryl stitch, first layer was continuous subcuticular inverting sutures. Second layer was closed using local tissues. Local flap was harvested from the left side and sutured over the urethroplasty as a waterproofing layer using 5-0 vicryl. Glans wings were widely mobilized and distal urethroplasty along with glansplasty was done using 5-0 vicryl.

Hypospadias repair in a boy
Hypospadias repair in a boy

3 a & b Picture showing site of oral mucosa graft harvest i.e upper lip and oral mucosa graft, it has been placed and quilted in the urethral bed.

Hypospadias repair in a boy
Hypospadias repair in a boy

4 a & b: Distal urethroplasty completed and local flap harvested from the left side.

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Hypospadias repair in a boy

5 a & b: Local flap sutured over the urethroplasty, and second picture shows completion of the entire repair.

After undergoing hypospadias repair in a boy, the patient had a per urethral catheter and suprapubic cystostomy (SPC). Dressing change was done on postoperative day 4 followed by operated site inspection on every 4th day. Per urethral catheter was removed on postoperative day 21 and SPC was removed on postoperative day 22.

Hypospadias repair in a boy
Hypospadias repair in a boy

6. Picture showing status at post operative day 15 and second picture shows urine stream after catheter removal. 

Post catheter removal, he was passing urine in single straight stream with no leak. Patient was started on meatal dilatation using meatal dilator with mild steroid ointment for 3 months. 

Testimonial from the boy’s father in his own words:

We are from South Africa. We got reference of Dr. Singal from a website, post which I got an appointment. Post which they did a proper evaluation and told that he had to undergo a redo hypospadias repair. Based on the evaluation, he had to do redo surgery for hypospadias repair in a boy. We came here on 22nd of December, procedure was properly explained to us. The surgery went well, post care after the surgery was also extremely good. Total support staff, hospital staff took care of my son very well. After the surgery, the discharge process was very fine, post care after discharge was also very good. The steps were properly explained. Today we are finishing the treatment and going out of India to South Africa. From my experience, the overall procedure was very good and extremely satisfying.

Single Stage Hypospadias Repair In A Boy After Multiple Failed Hypospadias Surgeries

Failed hypospadias repair refers to a situation where the initial surgery to correct hypospadias was not successful. Inspite of the best efforts by the surgeon the complications may happen because every healing of every hypospadias patient is different. We do not know the exact reason for complications after hypospadias surgery but here are some factors which may contribute to post-surgery complications:

  1. Severity of hypospadias: Severe hypospadias repair is more complex and more challenging than mild hypospadias. Total healing time in hypospadias is 3- 4 weeks and it is longer in severe hypospadias. To minimize the risk of complications in severe hypospadias repair, the entire repair may have to be done in 2-3 stages.
  2. Surgical technique: Different surgical techniques have varying success rates, and the choice of technique can impact the outcome. The choice of technique depends on the type of hypospadias, degree of chordee, glans diameter etc. An expert hypospadias surgeon will choose the best technique after considering all the factors because no two techniques are the same, and no two hypospadias are the same.
  3. Experience of the surgeon: The experience of a surgeon is an important factor for successful hypospadias surgery. Centre performing more than 50 surgeries per year will have lesser complications compared to the other centres.
  4. Wound healing: Wound healing is an important deciding factor in complications after any surgery. In hypospadias, wound healing is very slow in adults as compared to children. This may be because of decreased cell turnover with age, a weakened immune system, and reduced blood flow. And if they have any preexisting co-morbid illnesses then healing is slower, with a higher risk of complications.
  5. Age at surgery: The best age to undergo hypospadias surgery is between 6 and 18 months of age. If not done at this age, it should ideally be done by 5 years of age. Parents are sometimes unable to get the surgery done within 5 years of age, and these children, when they reach adulthood, realize that they need surgery to correct the hypospadias. Outcomes in later age are little inferior to childhood hypospadias surgery but still possible. Adults with hypospadias need not lose hope because it’s better late than never. At Hypospadias Foundation, we have been able to achieve good outcomes with cosmetic result with a success rate of more than 90%, even in adults after multiple previous failed surgeries.
  6. Underlying medical conditions: Obese or overweight adults, smokers, poor nutritional status, and diabetes are some of the conditions that can lead to slow healing. Overweight patients or diabetics can develop insulin resistance, causing poor healing. Smokers, nutritional deficiencies, etc. can cause decreased blood flow to the operated site, associated with decreased collagen production, which in turn causes slow healing.

Impact and Considerations after failed hypospadias repair:

A failed hypospadias repair can have both physical and emotional consequences for an individual with adult hypospadias and for parents of kids suffering from hypospadias. Complications that can occur after hypospadias repair are:

  1. Urinary problems: difficulty in urinating, spraying of urine (glans dehiscence), urine passage from multiple holes (fistula), pain in urinating, or urinary tract infections, swelling pf penis during voiding (diverticulum), problems with ejaculation, post void dribbling,
  2. Residual chordee (curvature): The penis may remain bent, affecting sexual intercourse and, in turn, leading to sexual dysfunction.
  3. Cosmetic appearance: The meatus may be at a slightly lower level than normal. This may be disturbing for some individuals. In this case, there will be no problems in passing urine, and it is merely the way it looks different from others.
  4. Psychological impact: As a parent, you may feel helpless and angry after a failed hypospadias. Failure of hypospadias surgery can cause feelings of anxiety, frustration, suicidal tendency, and low self-esteem in an adult. At certain times, adults may need pre- surgery counseling to reduce anxiety and stress. By improving your communication with your doctor and understanding the risks and benefits of surgery, you are more likely to be satisfied with the outcome.

Seeking Help:

If you or someone you know has a failed hypospadias, it’s crucial to seek professional help from a urologist specializing in pediatric urology or hypospadias. They can assess the situation, discuss treatment options, and provide guidance and support throughout the process. Even after previous unsuccessful repairs, there is more than 90% chance that with an expert hypospadias surgeon, the complications can be managed, and your hypospadias can be fully cured.

About Hypospadias Foundation 

At Hypospadias Foundation, we get adults and children from all over the world in search of treatment for hypospadias. We provide support and information for children, adults, and their families affected by hypospadias. Dr Singal and Dr Shenoy are deeply devoted to creating awareness and helping patients get the right treatment and best outcomes for hypospadias. Children and adults from more than 25 countries visit Hypospadias Foundation in search of treatment for hypospadias.

Dr A K Singal is a highly experienced surgeon and is regarded as the best hypospadias surgeon in India and in the world for treating children and adults with hypospadias. If you are looking for a highly skilled and experienced pediatric urologist and hypospadias surgeon for yourself or your child, then Dr Singal is an excellent choice.

Dr Ashwitha Shenoy is an expert pediatric surgeon with a special interest in pediatric urology and hypospadias. Dr Singal and Dr Shenoy’s collaboration allows them to offer advanced surgical techniques and comprehensive care for patients.

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: +91-9324180553 (whatsapp), +916262840940, +916262690790 Or email us at hypospadiasfoundationindia@gmail.com

Keywords: best hypospadias surgeon India, Best hypospadias surgeon world, complicated hypospadias repair, oral mucosa graft repair, oral mucosa inlay graft, Hypospadias repair in small penis, failed hypospadias repair, oral mucosa graft urethroplasty, results of hypospadias surgery, failed hypospadias surgery, complications of hypospadias, hypospadias surgery, hypospadias surgeon south Africa,

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    Two stage oral mucosa graft repair in redo hypospadias

    A 3 year 6 months male child presented to us in the OPD after two failed surgeries for hypospadias (done elsewhere). He had undergone a staged hypospadias repair at another centre in Mumbai and when he came to us, he had meatus at the proximal penile region probably due to complete dehiscence after stage 2 repair. The child was very apprehensive in the OPD because of a traumatic experience from previous surgery. On examination, the meatus was in the proximal penile region with very irregular unhealthy skin beyond that. At our centre, he was planned for cystoscopy, chordee assessment and most likely a staged oral mucosa graft hypospadias repair for best outcome.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    On clinical examination, the meatus was at the proximal penile region with
    unhealthy distal skin.

    At the start of hypospadias surgery, chordee was assessed and there was no residual chordee noted. Deep degloving was done, all fibrotic tissues from the urethral bed were removed. Proximal urethra was mobilized. Chordee was reassessed and no chordee was noted. Skin was rearranged on the dorsal and ventral side. Raw area of 4x2cm was noted on the ventral aspect. Hence, we planned a stage 1 OMG repair i.e placement of oral mucosa graft.

    Oral mucosa graft was harvested from the right cheek and placed on the ventral side from the glans till the meatus. Graft was quilted thoroughly on the corpora using 6-0 PDS.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    Chordee was assessed, no residual chordee noted. Deep degloving done, all fibrotic tissues excised.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    Skin rearranged on the dorsal and ventral side. 4cm raw area on the ventral side noted.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    Oral mucosa graft harvested from the right cheek of size 4x2cm. Oral mucosa graft sutured on the ventral side from the glans till all around the meatus.

    After stage 1, graft healing was good. Steroid massage was started 3 weeks after surgery and was continued for 5 months. Graft uptake was 100%. Second stage was planned after 6 months when the graft was soft and pliable. During the second stage hypospadias repair, chordee was reassessed and no chordee noted. Local anaesthesia – lignocaine with adrenaline was injected at the edges of the graft. Graft was incised at the margins and tubularized over a 7Fr Infant feeding tube (IFT). Second layer was closed using local tissues. Dartos flap was harvested from the left side and sutured over the urethroplasty using 6-0 PDS. Glans wings were widely mobilized and Glansplasty was done using 6-0 PDS. Glans epithelium was closed using 6-0 PDS. Skin was closed in 2 layers using 6-0 PDS and 6-0 vicryl rapide.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    Graft was soft, 6 months after stage 1 repair. Chordee was assessed and no chordee was noted.

    VVG 13
    oral mucosa graft repair hypospadias

    Graft was measured and 18mm width was used for urethroplasty. Graft was incised all around and tubularized and sutured using continuous inverting subcuticular sutures using 6-0 PDS.

    oral mucosa graft repair hypospadias
    oral mucosa graft repair hypospadias

    Dartos flap sutured over the urethroplasty. Glansplasty and skin done hence completing Stage 2 OMG urethroplasty.

    Dressing change was done after 7 days, and catheter was removed after 10 days. After catheter removal, the child passed urine in single straight stream with no pain or leak.

    oral mucosa graft repair hypospadias

    Post catheter removal, passing urine in single straight stream with no complications.

    Two stage oral mucosa graft repair in redo hypospadias

    Hypospadias is usually diagnosed after birth in the neonatal period by a pediatrician. Once diagnosed, referral to a pediatric urologist is necessary to plan surgery at the right age. As per the guidelines the best age for hypospadias surgery is between 9 to 18 months. Hypospadias Surgery is planned in single or two stages depending on the severity of hypospadias. After chordee correction, usually there is insufficient skin on the underside of the penis to reconstruct the urethra hence extra tissues either in the form of prepuce (in primary ones) and oral mucosa graft (in redo cases) are used for urethroplasty.

    Prepucial skin can be mostly used only once for the hypospadias repair. If the first surgery is unsuccessful then we need to plan redo surgery by using skin from somewhere else due to lack of local prepucial skin. In these children, use of oral mucosa graft is an excellent option. The reason why oral mucosa can be used for urethral reconstruction is because it is hairless, thin and pliable similar to the natural lining of the urethra. Graft is harvested from the inside of the cheek or lip, fatty tissue from the graft is removed. The penis is prepared for placement of the graft and the graft is meticulously sutured on the corporal bed. The graft incorporates into the urethral bed and becomes soft in 6-8 months. Local Steroid massage is necessary to make the graft soft. Once it is as soft as lip it can be tubularized to form the neourethra. The beauty of oral graft is such that there is less risk of fistula formation, minimal donor site scarring and has good cosmetic outcomes. However, it requires specialized skill and experience to perform oral mucosa graft in hypospadias and there is a small percentage of adults or children who may develop graft rejection or failure. In these children or adults, we need to replace the graft completely by a new graft.

    The above-mentioned case is of a boy who presented to us after two failed hypospadias surgeries in the past. The local prepucial skin was unhealthy, hence we opted for oral mucosa graft. The final cosmetic result in this boy was excellent and he was able to pass urine in single straight stream with no complications.

    At Hypospadias Foundation in Navi Mumbai, after hypospadias repair including oral mucosa inlay graft urethroplasty, children are encouraged to walk, play, and do some activities at home comfortably. We do not advice bed rest. Tying the legs and restricting children from doing activities or walking is disturbing for the child. Encouraging them to do activities can act as a distraction and take their mind off from the discomfort and promote healing. With our vast experience in hypospadias, we would recommend that children be allowed to do some activities in the post operative period. Play can be powerful tool for children to express their emotions and process surgical fear.

    About Hypospadias foundation

    Hypospadias foundation is an organization dedicated for children and adults with hypospadias and is rated as the best hospital for hypospadias repair in India. It was founded in 2008 by Dr A K Singal and is located in Kharghar, Navi Mumbai. Hypospadias foundation offers best results for surgical repair for primary and failed hypospadias. We at hypospadias foundation believe in providing personalized care and psychosocial support to families of children and adults with hypospadias. The foundation also advocates improved access of care for people with hypospadias around the world.

    Dr A K Singal is a well renowned hypospadias surgeon and regarded as the best hypospadias surgeon in India and in the world. His vision for hypospadias has helped him achieve excellent outcomes in adults and children with hypospadias. He has dedicated his life in treating children and adults with hypospadias with his innovative surgical techniques.

    Dr Ashwitha Shenoy is an expert pediatric surgeon with special interest in pediatric urology and hypospadias. She holds a particular interest in hypospadias and along with Dr Singal performs advanced surgical techniques for both primary and complex hypospadias cases in children and adults.

    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: +91-9324180553. Or email us at hypospadiasfoundationindia@gmail.com

    or pls call up our clinic for an appointment – +91-9324180553

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