International Patients
+916262690790

Tag Archives: hypospadias fistula

HomeHypospadias Foundation   hypospadias fistula
October 10 2013

Hypospadias Surgery In India

Author Dr. A.K.Singal Categories About Hypospadias

Every year more than 100,000 (1 lakh) boys are born with hypospadias in India.  It is s staggering number.

This incidence has been calculated from birth rate for male babies according to Census 2011 and considering that the worldwide accepted incidence of hypospadias is around 1/150 male births. Further we have adjusted this for infant mortality rate. Though our own research in a population study done by Hypospadias Foundation in Vashi & Nerul areas of Navi Mumbai has shown an incidence of hypospadias around 1/126 male births, the base population was only  1200 births which was not very big, hence we did not use this figure.

At Hypospadias Foundation, we are concerned about this increasing incidence of hypospadias across the globe and we are planning to devote time and resources towards research. At the same time, even if we ignore minor hypospadias and those babies without chordee, in whom we can avoid surgery, still about 70,000-80,000 babies will need hypospadias repair surgeries in India every year.

In India, hypospadias repair surgeries are performed by pediatric urologists (wherever available), pediatric surgeons, urologists as well as some plastic surgeons. Some of these surgeons have learnt the art of hypospadias surgery with a formal pediatric urology training while others have gained experience due to their personal interest and have achieved good results. Fortunately, there are short team visiting courses available at some international centres  and also with the availability of good learning resources on internet, surgeon with special interests in hypospadias can explore multiple avenues for training. Infact the current generation of hypospadias surgeons is learning quickly and also starting their careers at a better knowledge base than surgeons who were learning hypospadias two decades back. Newer instruments, newer surgery techniques and sutures have improved the hypospadias repair outcomes.

At centres like Hypospadias Foundation at MITR Hospital, Navi Mumbai, India – a team  of two surgeons with special interest in Hypospadias – Pediatric Urologist & Hypospadiologist- Dr A.K.Singal and adult urologist – Dr Manish Dubey- work together to enhance the outcomes of surgery both in in children as well as adults with hypospadias. While the aim of the team is to spread awareness and also provide for early surgery in infancy for children with hypospadias, they are also reaching out gradually to many older children and adults with failed hypospadias repairs, persisting or residual hypospadias issues. At Hypospadias Foundation, almost every week, the team gets to see an adolescent or an adult with persistent hypospadias issues such as chordee, urethral fistula, urethral stricture, or poor cosmetic outcome such as buried penis. Some of these patients have multiple problems either due to partly or improperly repaired hypospadias in childhood. These cases are looked after by the team with special attention and effort. You can see such a cases:

14 years old Multiple failed hypospadias surgeries in childhood

With growing team and experience, the number of children and adults undergoing hypospadias surgery at Hypospadias foundation have steadily increased over the last five years. This year in 2013, we will finish with around 150 hypospadias surgeries and though it is good but it not even 1% of the total burden in India. We hope to start training pediatric surgeons and urologists so that within India there is facility for budding surgeons to learn the state of art hypospadias surgery.

Healthcare and specifically surgery is all about trust and for complicated diseases like hypospadias it takes time to achieve trust. Every single child who has undergone a successful surgery at Hypospadias Foundation, the family has spread the goodwill and good word about the dedication of our team.  In the last two years, we have been lucky to be a part of treatment process and lives of lot of outstation and international patients – some have come in from Surat, Jalgaon, Nasik, Kolhapur while others have travelled even from Delhi, Ahmedabad, Bangalore, Jaipur and even as far as Jammu or Calcutta. Internationally, we now offer assistance to 1-2 patients every month from countries like Sri lanka, Bangladesh, Pakistan, Nigeria, Kenya, UAE and Congo. Most of the patients who travel these large distances are either failed hypospadias or complex hypospadias who haven’t been able to get satisfactory counseling or answer to their problems.

Our team at Hypospadias Foundation helps the families with email guidance, online consults, follow-ups and planning travel and surgeries according to availability of Dr Singal and Dr Dubey.

You can watch Videos of Hypospadias Surgery on our youtube channel:

Hypospadias Channel

Videos:

Distal penile hypospadias repair

Severe Hypospadias single stage repair by Dr Singal

Contact Hypospadias Foundation

Dr A.K.Singal can be contacted at

  1. MITR Hospital & Hypospadias Foundation, Kharghar – 022-27742558/ 4229  & 9324180553

Mon/ Wed/ Fri 5:00-6:00pm

  1. MGM Hospital Vashi – 02261526666, 6607

Mon/ Wed/ Fri 7:00-8:00pm

  1. MITR Clinic, Vashi- 02265163816, 9324502572

Tue/ Saturday 7:00-8:00pm

  1. Fortis Hospital, Sector-9, Vashi- 02239199222, 200

Tue/ Saturday 6:00-7:00pm

Watch our youtube channel for videos of Hypospadias surgery – Pediatric Urology & Hypospadias Channel

You can write to us at dr Singal’s email Id – arbinders@gmail.com  for a second opinion or guidance.

Contact Form for Hypospadias Foundation

Please fill all clinical details and upload pictures and clinical summaries (if available)

    Attach Documents (pdf | jpeg | mp4)
    (upload size upto 5mb)

    September 09 2012

    Hypospadias in Adults- Setting the right goals and expectations

    Author Dr. A.K.Singal Categories Adult hypospadias

    I get a lot of enquiries about hypospadias through our Hypospadias foundation website – Most of these are from concerned parents, sometimes  from relatives, sometimes from referring doctors but rarely from patients themselves. For writing about themselves, the patients have to be old enough to go on Internet and seek help. And with advancing awareness, these days most of the kids are referred to me in first few months of age and sometimes even in newborn age. So to get an inquiry from a patient happens only a couple of times in a month. And most of these are enquiries before an impending marriage!

    I was intrigued when I got an email from a VK 34 years old man wanting to consult me for hypospadias. My assistant, Akshay, explained to him about my consultation time at MGM vashi and at Mitr hospital.

    On Monday evening, VK wrote to me again saying that he went to MGM Vashi but they refused to make a file for him and sent him back with the explanation that Dr Singal treats only kids till 15 years of age. I felt really bad and I sent an email back to him and asked Akshay to schedule an out of turn consultation for the young man on Tuesday. Tuesday otherwise is usually my free day.

    So Tuesday evening, in walked VK, a smart confident young man. He was working as a senior software analyst in a well known consulting company and was married for last 3 years. The consultation began on a nice note. I went through all the papers dating back to one year of age. VK was born with a scrotal hypospadias and had undergone two stage repair at Wadia Hospital when he was 5 years of age, thereafter he had required a couple of minor procedures for narrowing of passage and urethral fistula but was mostly passing urine well. His main reason for consultation at this time was infertility. Secondary issue which we discussed was splaying of urine at time of passing urine. His urine came out in a form a spray rather than a well directed stream and he would often wet his pants and thus found it difficult to use a urinal for expeditious passing of urine.

    His sperm count was almost normal and he was able to have normal erections and ejaculations. The ejaculate was not forceful so an intrauterine insemination (IUI) had been tried but two sessions had failed.

    His secondary problem of a sprayed kind of urine stream was due to a wide open urinary meatus (hole) with a funnel kind of appearance and lot of loose skin folds around it. Also, the urinary opening was not at the tip of the penis but was rather on the underside about 3 cm from the tip.

    From a functional point of view, the location of the urinary opening was not in too bad a location to cause infertility.  Also, since IUI had failed, I was sure that the infertility problem was not due to hypospadias per se. Given the high incidence of primary infertility these days and advanced age of the mother (34 years), the infertility may have been because of some other factors.

    In his own mind, VK had thought that it was his hypospadias problem which was causing infertility. I spent close to 40 minutes trying to draw diagrams and explaining to him that we should look for other causes of infertility.  Finally, he was convinced and then I referred him to an infertility specialist and an andrologist. The plan was:

    • Re-evaluation of fertility status by checking all the reports of husband and wife again
    • Trial of In-vitro fertilization for having a child
    • And then repair of the hypospadias from urinary point of view once wife if pregnant.

    Both for the patient and the surgeon, it is very important to have the goals and expectations from any treatment set at the beginning of the treatment itself. VK had come to me with a primary issue of infertility and the secondary issue was urinary splaying due to incompletely repaired hypospadias. By solving his hypospadias issue, we could not have solved his infertility problem and I did not want him to have any false hopes and thus get surgery done for the wrong reason/ indication. Overall, VK was very happy with the plan. I hope that he will have a baby soon and then we will fix his rest of the urinary issues in a single stage and well.

    Over the last few years, our team – myself and Dr Manish Dubey have treated about 20 adults with various kinds of hypospadias and residual problems. Some of these have been for urethral fistulas, others for residual chordee or cosmetic issues. Most of these have come just before marriage or when they are facing issues such as VK. A couple of patients actually travelled from south India and one from Dubai to get treated.

    Contact Form for Hypospadias Foundation

    Please fill all clinical details and upload pictures and clinical summaries (if available)

      Attach Documents (pdf | jpeg | mp4)
      (upload size upto 5mb)

      July 07 2012

      How to prevent failures in Hypospadias Surgery (Urethroplasty)

      Author Dr. A.K.Singal Categories Hypospadias Surgery

      Hypospadias is a complex and challenging clinical problem. Worldwide accepted failure rates for single stage hypospadias repair (urethroplasty) are 5-10% and these children who have encountered a failure require a second surgery. This situation is never pleasant for the surgeon or the parents or the child who is actually undergoing another surgery. The key thing to understand here is that everyone including the parents and the doctors are on the same side in this situation and everyone wants the child to get better.

      Infact when the parents come and see me in the clinic and ask about my second surgery or failure rates – I often tell them “I want your kid to have only one surgery, you want your kid to have only one surgery and the whole reason why you came to meet me and came to know that there is someone called Dr Singal is that your son has hypospadias. Our goals are, thus, aligned towards pursuing a good result with only one surgery in mind but at the same time realizing that inspite of our best intentions and experience and all the money and the efforts, 5% of the kids may still require a second surgery. Another reassuring fact is that the second surgeries are often minor with faster recovery and overall at the end of it all the child would be absolutely normal in almost all the cases. The only difficulty is to assess with full surety which child will have a failed surgery. For the child whom the second surgery becomes a reality the individual failure rate is thus 100% and for the rest the result is 100%”

      Fortunately, there are some fine pointers which tell us about the increased risk of second surgery. These are:

      • Severe hypospadias
      • Severe chordee (the penis is very bent)
      • Associated issues like chromosomal problems or disorder of sex development.

      The steps which one takes to avoid failure in hypospadias have to be titrated for each case thus giving each child undivided individual attention and care. Some of the mantras in avoiding pitfalls are:

      • Spending enough time to understand the subtle nuances and variations in anatomy of every case.
      • Proper selection of technique of surgery- single most important step in ensuring good outcome. There are over 100 techniques described for hypospadias repair. Most of the surgeons master 4-5 techniques and then for every case we have to diligently assess and assign a technique. This is best done at the time of surgery in the operation theatre. That is why a proper training, experience and dedication is very important in assuring good results. Pediatric urology training allows a surgeon to be flexible in the approach and decide at the last moment and even change the technique if something is not working out. It is akin to waiting for a ball to spin and then playing a shot called “late cut” in cricket. The whole hypospadias repair mirrors that philosophy.
      • A thorough re-operative assessment of the child for nutritional and health status is very important. The hemoglobin should be atleast 10gm% and the overall child should be well nourished so that the tissues will heal faster and better after surgery.
      • Fitness for anesthesia: Hypospadias surgeries require general anesthesia for the child. It is very important that blood tests and urine tests are normal for the child. Also, a very good clinical examination is done to make sure that the child does not have any other coexisting abnormality of infection such as chest infection, cough, cold, diarrhea or skin infection. Infection anywhere in the body makes the body weak as the body is consuming energy in fighting the infection and thus healing would be delayed. Also, there is a risk of a cross infection in the operated area. Since hypospadias is not an emergency, ideally we should wait till the child is fully well and in the “Pink of the health” (so to speak) before surgery.
      • Planning the surgery in a dedicated, good, well equipped & sterile operation theatre to prevent infection
      • Having microsurgical instruments which are dedicated only towards hypospadias repair and not used for any other surgery. Infact I personally have 3 such sets allowing me to sometimes perform 2-3 hypospadias repairs in one day
      • Using a magnifying loupe during surgery to perform surgery with finesse. Magnification helps in proper and fine dissection of tissues. Also the stitches used are of very fine caliber so magnification helps in tying knots properly.
      • Working with fine sutures- this goes hand in hand with using magnification since using magnification allows surgeon to use finer sutures.
      • Trained staff for surgery and post-operative care.

      In the end it is important to remember that for a child with hypospadias, first surgery is the best chance at a complete functional and cosmetic result. Pediatric Urologist and the medical team should make sure and do whatever in their power to give the child a 100% result in the first stage.
      natural penis enlargement pills

      Contact Form for Hypospadias Foundation

      Please fill all clinical details and upload pictures and clinical summaries (if available)

        Attach Documents (pdf | jpeg | mp4)
        (upload size upto 5mb)

        1 2