Notice the ventral defect in prepuce is small in this case of distal hypospadias

Completed Foreskin Reconstruction (prepucioplasty)

About Hypospadias Foundation:

Hypospadias foundation is a centre which provides personalized care for children and adults with hypospadias. It is the best hospital centre in India and world for surgical treatment for hypospadias in adults and children.  Our dedication in the field of hypospadias has helped us achieve excellent outcomes in these patients. We treat children and adults not only from various parts of India but also from more than 25 countries all over the world. Hypospadias foundation is located at MITR hospital in Kharghar, Navi-Mumbai, Maharashtra, India. Every year more than 200 surgeries of hypospadias are performed at MITR hospital.

Dr A K Singal and Dr Ashwitha Shenoy are expert surgeons for Hypospadias in India. Working together as a team they have achieved excellent outcomes in primary and failed hypospadias in children as well as adults.

For appointment with Dr Singal or Dr Shenoy, kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India-  Call for appointments: +91-2227743558/ 27744229/ 39/69 and +91-9324180553.

MITR Clinic: C1/8 Ground floor, Sector-2, Vashi, Navi Mumbai, India – Call: +91-9324502572

We are privileged to care for children from across the world who come with their parents to our Hypospadias centre in Navi Mumbai, India looking for the best in Hypospadias surgery and treatment. The love and affection which we give to the kids is a mirror image of the trust and faith which family puts in us. It is the simple rule of medical care and cure.

Happy kids= happy parents = good results= happy surgeon who sleeps well. Our nurses and junior doctors almost adopt the kid as one of theirs and then play with the kid during recovery time and we see that with such a personalized care the kids recover after hypospadias surgery in no time.

Somebody said it aptly, “When you are happy the time flies very fast”. Hence, if everyone remains happy and in high spirits after a hypospadias surgery, time just disappears. Long journey to India and time spent here seems worthwhile.

The Email from Dhaka, Bangladesh:

Dear Sir,

Here is our testimony. As you know we are from Dhaka city in Bangladesh and when our son, baby Satyaki Sarkar, was born, he had a problem which the doctors named distal penile hypospadias. So when doctor told us about this problem we were very worried. We didn’t know what to do because we never heard the name of such type of problem. I searched in internet about the problem for best doctor for hypospadias. After searching internet we got the address of Dr. Arbinder Singal, Hypospadias specialist surgeon and Hypospadias Foundation in Navi Mumbai, India. We also watched the video of hypospadias repair surgery which they had uploaded related to surgery about hypospadias of a baby. We also studied the articles of Dr. Singal and others hypospadias surgeons around the world. After that we finally decided to do the hypospadias repair surgery in Navi Mumbai India, at MITR Hospital & Hypospadias foundation. We contacted with the authority of Hypospadias foundation for getting appointment. Ms. Emily Paul and Dr. Rajkumar Gupta arranged appointment for us in a cordial way.

Now it was time for hypospadias surgery. We met with Dr. Singal on 21st March. He appointed us on 23rd March for operation. We were so tensed about Satyaki’s operation. But Dr. Singal and his team were so cooperative that we forgot about all tensions and focused only on Satyaki’s operation. At last, on 23rd March, 2015, the hypospadias operation was done successfully without any problem. After having surgery we stayed in the hospital for one day and the next day they discharged us. After having surgery we felt that we came in the right place because my baby had no surgical pains. He recovered so quickly that we couldn’t imagine. We realized that best results are possible after hypospadias surgery.
We would like to specially mention about the nurses and staffs of hypospadias foundation. They were so cooperative, and cordial. They can manage the babies with hypospadias after surgery in a very caring and professional way.
Now my little boy is completely recovered and doing well without any problem. You may post the picture of my baby and us which you have to us. Because we think that this may help to realize the families that hypospadias problem may be solved through proper surgery. We also think that through our message and picture many families who are suffering from this problem will get new aspirations and hope.
At last we again want to give thanks to Dr. Singal and his team for doing this surgery in an excellent way. We wish success of this foundation in every step of its life.
With best regards

Sanjeev Kumar Sarkar
Father of Satyaki Sarkar
Dhaka, Bangladesh.

Hypospadias is one of the most common urological anomalies in boys. While 80% of all hypospadias are mild and of distal or midpenile, 20% are proximal hypospadias. Severe varieties like scrotal hypospadias form only 5% of total burden of hypospadias. Severe hypospadias such as scrotal hypospadias often have associated chordee (bent penis) and this may be very severe too posing a challenge for the hypospadias surgeon. We have realized in last few years that making the penis straight (chordee correction) is THE MOST IMPORTANT step of hypospadias repair procedure. While most of the severe scrotal hypospadias are also repaired in a single stage (almost 90% are suitable for a single stage urethroplasty), in 10% of the children the anomaly is so severe especially due to severe chordee that two stage repair may be better for an optimal long term outcome.

Master R.P. was born with scrotal hypospadias, severe chordee in Patna, Bihar and was advised to undergo surgery after 1 year of age. The parents went to multiple doctors in Patna, Delhi and finally came to consult Dr A.K.Singal, renowned Hypospadias surgeon at MITR Hospital, Navi Mumbai. On examination, the child had a severe scrotal hypospadias, severe chordee (almost 90 degrees) and abnormally fused skin of scrotum to the penis. This almost looked like a trapped hypospadias penis due to skin shortage. Dr Singal discussed in detail with parents that such a severe hypospadias may require hypospadias treatment in stages. Due to the severity it may be impossible to correct all the defects in one surgery. Also the penis length may have got shortened and cosmetic result would also been suboptimal.

Finally, R.P. was taken under anesthesia and hypospadias repair surgery was started. As a first step the penis was degloved. Urethral plate was divided and the fibrous bands causing chordee on the underside of penis were divided deeply till the scrotum. The penis was almost straight after this maneuver with just 30 degree bend which was further corrected by a placing a placating stitch on the top side of penis (tunica albuginea plication or TAP). Artificial erection test confirmed the complete correction of chordee. Since the chordee was severe and the urethral plate was also divided, single stage surgery would have carried very high failure rates. Hence, a staged urethroplasty was planned. The skin on the top of the penis was divided in midline and brought to the underside of penis. A part of the skin was advanced into the head of penis (glans) so that the new urethra in next stage would be constructed till the tip of penis. This is called Thiersch Byar’s urethroplasty stage-1. There was a compression dressing done which was removed after 7 days and the family travelled back to Patna after a total of 14 days after first hypospadias surgery.

Hypospadias is one of the most common urological anomalies in boys. While 80% of all hypospadias are mild and of distal or midpenile, 20% are proximal hypospadias. Severe varieties like scrotal hypospadias form only 5% of total burden of hypospadias. Severe hypospadias such as scrotal hypospadias often have associated chordee (bent penis) and this may be very severe too posing a challenge for the hypospadias surgeon. We have realized in last few years that making the penis straight (chordee correction) is THE MOST IMPORTANT step of hypospadias repair procedure. While most of the severe scrotal hypospadias are also repaired in a single stage (almost 90% are suitable for a single stage urethroplasty), in 10% of the children the anomaly is so severe especially due to severe chordee that two stage repair may be better for an optimal long term outcome.

Master R.P. was born with scrotal hypospadias, severe chordee in Patna, Bihar and was advised to undergo surgery after 1 year of age. The parents went to multiple doctors in Patna, Delhi and finally came to consult Dr A.K.Singal, renowned Hypospadias surgeon at MITR Hospital, Navi Mumbai. On examination, the child had a severe scrotal hypospadias, severe chordee (almost 90 degrees) and abnormally fused skin of scrotum to the penis. This almost looked like a trapped hypospadias penis due to skin shortage. Dr Singal discussed in detail with parents that such a severe hypospadias may require hypospadias treatment in stages. Due to the severity it may be impossible to correct all the defects in one surgery. Also the penis length may have got shortened and cosmetic result would also been suboptimal.

Mr T.R., now 30 years old, was born in Dhaka city in Bangladesh with a urological anomaly called Hypospadias in which the urinary opening is on the underside of the penis rather than the tip. Hypospadias also leads to a downward curvature of the penis called Chordee. Hypospadias always needs surgery, a specialized procedure called Urethroplasty which is done by trained Pediatric Urologist surgeons in childhood itself. Unfortunately, due to lack of awareness and non-availability of Pediatric Urologist doctor in Bangladesh, his parents did not get any surgery done for him. Mr T.R. was a good student and did postgraduate in commerce and got a job with an international bank. He had always thought something was abnormal with his penis and hence started searching for specialist doctor for hypospadias surgery. He found out about Bumrungrad hospital in Thailand and Hypospadias Foundation at MITR Hospital in Kharghar, Navi Mumbai. He sent his medical records to both the places but after exchanging a few emails with Dr A.K.Singal, Pediatric Urologist who managed Hypospadias Foundation, decided to travel to Navi Mumbai for his treatment. He came to Kharghar in September 2014 and after a few tests for fitness for surgery and anesthesia underwent Urethroplasty surgery under care of a team of two surgeons: Dr A.K.Singal, Pediatric Urologist and Dr Manish Dubey, Adult urologist. This is the same team which started Hypospadias foundation 6 years back. The whole surgery was performed in one stage and took three hours. T.R. also had a significant chordee and chordee correction surgery was done at the same time as hypospadias repair procedure. He was discharged to hotel in 2 days. Mr. T.R. recovered well after surgery and the catheter was removed after 14 days. Initially he had a little difficulty in passing urine but settled over the next few weeks.  He has sent us reports of uroflowmetry from Bangladesh and they show a good urine flow of urine from the tip of penis.

Dr Singal said “Hypospadias is one of the most common birth defect in children but due to stigma attached to penile deformity no one talks about it. About 1 lakhs kids are born in India every year with this problem and ideally they should be operated by 1.5 years of age. There are an estimated 5 lakh adults and failed hypospadias surgery cases who are suffering and unable to get a cure as the surgeries 20 years back did not have such good results as we have now. Dr Manish Dubey and I started Hypospadias Foundation in 2008 as these children and families need lot of counselling and psychological support beyond surgery for full cure. Also the surgery is difficult and complicated, requires lot of patience and skill, and unless the surgeon is focused on taking this complicated issue head on, the results remain suboptimal. At hypospadias Foundation, we provide hypospadias treatment to more than 200 such children and adults every year and they come from all over India and from countries all over the world. Hypospadias Foundation remains world’s first and only organisation dedicated to caring for children and adults with hypospadias.”

Dr Manish Dubey said “We see lot of adult patients with issues from failed and un-operated hypospadias who come with psychological, infertility and urological issues. They don’t even know where to go for treatment and who is the right doctor for them as this is child urological abnormality which was not treated appropriately many years back. Here at Hypospadias Foundation, our team, does dedicated treatment to make sure that they recover on all aspects and become normal again.”

Dr Singal added “Adults take longer time to heal after hypospadias surgery. Coupled with spontaneous erections which occur in certain phases of sleep, it is little painful for initial few weeks. Over all the healing may take upto 2-3 months though one can join back work in 3-4 weeks after adult hypospadias surgery.

Mr T.R. said “I did a lot of research on internet before deciding to go to Navi Mumbai India for my hypospadias surgery. The focus and dedication with which Dr. Singal and Dr. Dubey manage patients with hypospadias is good to see. I am very thankful to Dr. Rajkumar also who took personal care for me when I was recovering. Besides, I found the full team of MITR is so helpful and caring that I didn’t feel uncomfortable during my stay. Especially I should have mentioned the name of Mrs. Emily who is an administrator of MITR Hospital, helped me a lot in every single stage with lovely smile. In terms of my treatment, I found Dr. Singal is very friendly and always listened me with lots of care. His hands on experience and depth of knowledge on this particular field makes him so confident which I liked most. Before my surgery I knew that hypospadias treatment on adult is so complicated thus I was in strain but after meeting Dr. Singal before my surgery made me so relaxed. After my surgery I felt complication while passing urine but Dr. Singal and Dr Dubey immediately managed the situation and solved the problem. Overall, it’s an excellent experience doing my surgery by Dr. Singal. I would strongly recommend Dr. Singal if anyone has been suffering from hypospadias in the adult stage. I would like to congratulate Dr. Singal and his team for doing the outstanding jobs. Wish the team all the very best.”

About Hypospadias Foundation:

Hypospadias Foundation is a part of MITR Hospital in Kharghar, Navi Mumbai, India and registered as a NGO under One Vision Health and Research Foundation. It was started by Dr A.K.Singal and Dr Manish Dubey on 26 Nov, 2008 and has to date treated more than 1000 kids and adults with hypospadias. Patients have come from virtually all states and major cities in India for Hypospadias treatment in Kharghar. Patients have also traveled from countries like Nigeria, Congo, Tanzania, UAE, Kuwait, Qatar, Greece, Nepal, Pakistan and Bangladesh.

Hypospadias Foundation aims to make sure that no child or adult is said no for surgery because of shortage of money or intent. Also, Hypospadias surgery training programs are planned in near future to train more surgeons to take care of Hypospadias Patients in a just, ethical and compassionate way.

Hypospadias Foundation was covered by yourstory.com, a leading online portal:

http://social.yourstory.com/2015/01/hypospadias/

Chordee means that the penis is bent (curved penis). Penis mostly gets bent downwards hence it is called ventral chordee and is seen commonly seen in children with hypospadias. In children with other type of anomaly which is much rarer than hypospadias called epispadias the penis may be bent upwards, it is called dorsal chordee. Hypospadias is atleast 20-30 times more common than epispadias, hence when someone uses the word chordee it is by fault supposed to mean ventral chordee as seen in hypospadias.

Why does chordee happen?

When the penis is getting formed between 8-12 weeks of pregnancy, the urethra (urinary passage) also starts getting formed from the base of penis to the tip of penis. This happens gradually under the 3influence of male hormones produced by the testis. All around urethra, a special tissue called corpus spongiosum is also formed through which the urethra runs. The two cylinders of tissue called corpus cavernosa are also formed. Together equal sizes of spongiosum and two cavernosa cylinder are responsible for a straight penis. When the urethra is short as in hypospadias, the spongiosum tissue is a3lso short, the skin and dartos tissue under skin is also short and sometimes the corpora can also be curved. Hence chordee results from this shortage of these tissues on underside of penis.

Do all hypospadias have chordee?

Chordee is seen more than 50% of all hypospadias but this also depends on the severity of hypospadias. Generally, the more severe the hypospadias is, higher the chances of chordee. Hence, chordee is more common in scrotal hypospadias than distal penile hypospadias. This is a generalization and it is not true in all cases as we have seen lot of cases of chordee without hypospadias and also minor hypospadias having a major degree of chordee.

How is chordee checked and graded?

Chordee can sometimes be seen by the parents when the child has an early morning erection which happens even in small babies. Generally we tell the parents to click the picture from the side to document the chordee degree. Chordee must always be checked during hypospadias surgery by doing an artificial erection test. This is infact a mandatory test for all hypospadias and the most important thing to be taken care of during hypospadias surgery. If chordee is not checked and left untreated, it can create lot of issues in adulthood and need surgery again which is much more difficult in adulthood. Chordee is graded in degrees like 30 degrees, 45 degrees or 90 degrees or also as mild, moderate or severe.

Does chordee always need surgery repair?

A straight penis is important to have straight stream of urine as well as for having normal sexual intercourse. Hence, if the penis has anything more than 15-20 degrees of bend should be corrected.

How is chordee repair surgery done?

• Degloving of penis: In any hypospadias surgery or chordee repair surgery, the first step is called degloving of penis. Degloving means that the penis skin is taken down till the base of penis by a circular incision around head of penis while saving the opening of hypospadias and urethral plate. Generally, there are some abnormal tissues around base of penis which cause chordee and once these are divided chordee gets corrected in most cases. Then a tourniquet is applied on the base of penis and saline solution is injected into the head of penis or corporal bodies. This is called artificial erection test and allows the hypospadias surgeon to assess the degree of chordee.
• Tunica albuginea plication: If there is still chordee then further steps need to be done to correct chordee. If the chordee is mild, then we perform tighten the top side of penis with a non-absorbable stitch to straighten the penis.
• Division of urethral plate: If the chordee is still severe then a cut needs to be given to divide the urethral plate between hypospadias opening and the head of penis.
• Dermal graft for chordee correction: Chordee is again checked and if it still severe then corpora needs to be lengthened by placing a dermal graft on underside of penis. In case a dermal graft is placed, then a single staged repair can’t be done and a staged hypospadias repair is done.

It is important for a hypospadias surgeon to make sure that the chordee is completely corrected during hypospadias surgery. It requires experience to do a stepwise assessment of the chordee in every individual case and then proceed with chordee repair as detailed above. The importance of having a straight penis cannot be overemphasized.

About the author:

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

Hypospadias is one of the most common malformations in boys and affects more than 1 lakh kids in India. At Hypospadias foundation and MITR Hospital, Kharghar, Navi Mumbai, India – we see and manage more than 200 kids every year who have hypospadias and need surgery. These cases are either primary (75%) or those have failed surgery elsewhere (25%)- some of them have failed multiple surgeries elsewhere.

We strongly believe that hypospadias surgical correction should not be taken lightly or casually by any surgeons as first hypospadias surgery is the best chance which the child has. Once the first hypospadias surgery has a complication, more surgeries are needed and still the result may not be optimal. Hence, the surgeon needs to be well trained for hypospadias repair procedure and should have a very keen and passionate interest before he takes up any child up for surgery for hypospadias.

Amongst the various techniques for hypospadias surgery, one of the most popular one is Tubularised Incised Plate (TIP) urethroplasty. TIP repair was first described by Prof Warren Snodgrass and it currently constitutes 70% of all distal and midpenile hypospadias repairs across the world. Due to its universal adoption and remarkable results, it is also known as Snodgrass repair. I had the good fortune of assisting Dr Warren Snodgrass during his multiple visits to India when I was a resident in pediatric surgery at All India Institute of Medical Sciences. I keep bumping him into now and then at pediatric urology conferences, the last one of which was European Society of Pediatric urology Congress in Genoa Italy. We received the best paper award at the conference and it was nice to see Dr Warren Snodgrass applauding us.

While TIP repair or Snodgrass urethroplasty has excellent results, case selection before surgery is very important. The criteria are:

1. Distal or midpenile hypospadias
2. Mild to moderate chordee which is correctable
3. Wide pink elastic urethral plate.

In certain selected proximal hypospadias, Snodgrass repair can be used but on a personal level- a long Snodgrass repair may not be the best option in most cases. We have started using Onlay Island flap repair in most of our proximal hypospadias and all distal/ mid penile hypospadias which are unsuitable for TIP Urethroplasty.

Steps of surgery:

1. Degloving the penis and chordee correction – straightening of the curvature of the penis
2. Midline urethral plate incision
3. Neo-urethra formation on a catheter
4. Second layer coverage with either a dartos flap or spongiosum
5. Penile skin cover with Byars flap which helps in creating a midline closure on underside of penis. After the healing is finished, penis looks like just a circumcised penis. In some selected cases Prepucial reconstruction can be offered.

You can watch the video of a Snodgrass Urethroplasty for a distal penile hypospadias here.

In my experience as an expert hypospadias surgeon, while doing TIP urethroplasty everything has to be done meticulously to prevent complications. If I have to narrow down on two things which have really lessened the complications of hypospadias repair with Snodgrass urethroplasty at our centre are:

• Fashioning a wide caliber neo-meatus- so that there is no narrowing later on
• Providing a second layer cover on new urethra with either spongiosum or a dartos flap.

Master Soham’s parents stay in Latur, Maharashtra and their son was diagnosed to have a distal penile hypospadias at birth. Worried about multiple surgeries and poor outcomes for hypospadias repair- They searched for the best hypospadias surgeon on the internet and landed up in our pediatric urology clinic at MITR Hospital in Kharghar, Navi Mumbai. We did the surgery using a Snodgrass repair technique in First week of May 2014. The surgery went well and child was discharged the evening of surgery. The dressing and catheter were removed 5 days after surgery and now one month after followup the child has an excellent outcome after hypospadias repair surgery. The cosmetic appearance is excellent with a meatus at the tip of penis, straight penis and just a circumcised appearance.

Parents are also happy and overjoyed.