single stage urethroplasty Archives - Hypospadias Foundation

April 04 2021

Single Stage Repair Surgery for Distal Hypospadias and Penile Torsion

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

10-month child was brought with complaints of deviation of urine stream and abnormal location of meatus. On clinical examination there was distal penile hypospadias with severe penile torsion measuring 90 degrees to the left. We planned a single stage correction for both Penile torsion and distal penile hypospadias.

Penile torsion

Notice Penile torsion to left

Distal Hypospadias with Penile torsion

Surgery Steps:

Marking of the degloving incision. Local anaesthesia was infiltrated at the marked incision site. Complete degloving was done and chordee was assessed using artificial erection test. 30-degree chordee was noted. Chordee correction was done by Tunica albuginea plication at 12’O clock on the dorsal side. Following this correction, chordee was reassessed and no chordee was noted. Urethroplasty was started by incising urethral plate in the midline. Urethroplasty was done over a 7Fr Infant feeding tube with 6-0 PDS continuous sutures. Dartos flap was harvested for extra coverage over urethroplasty which was sutured using 6-0 PDS. Penoscrotal web correction was also done. Excess skin excised and sutured using 5-0 vicryl rapide. Skin flaps were rotated and adjusted to correct the penile torsion and sutured all around using 5-0 vicryl rapide. Dressing and catheter were in situ for 7 days. Following 7 days, dressing and catheter was removed.

Penile torsion and Hypospadias repair

Finished Hypospadias and Penile torsion surgery

Final outcome of correction of penile torsion and hypospadias

Results

The Final result was very gratifying with a straight penis without any torsion. The child was passing urine in good stream in straight axis without any discomfort or pain.

About Hypospadias repair and penile torsion

Penile torsion is a condition wherein the penis is rotated or twisted on its axis. The penile torsion is more commonly to the left. Many a time penile torsion may not be detected till a circumcision is planned or foreskin is retracted.

Penile torsion may be associated with hypospadias and/or chordee (penile curvature). With hypospadias, penile torsion is mostly associated with distal penile cases.

Based on the degree of glanular rotation, penile torsion can be classified as mild, moderate, and severe. It is mild if its less than 45 degree, moderate if it’s between 45-90 degree and severe if more than 90 degree.

Penile torsion in majority of cases (>85%) is between 10 to 20 degree. If it is a moderate or severe degree of torsion, urine stream may be deviated to one side.

Surgical intervention is not always required in isolated penile torsion. The indications for surgical correction are cosmetic, functional, or sexual. When penile torsion is associated with hypospadias, it should be corrected along with Hypospadias repair or urethroplasty at the same time.

About Hypospadias Foundation

Hypospadias foundation is a centre which provides personalized and best quality care for children and adults with hypospadias. It is one of the best hospital centres 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 for hypospadias are performed at MITR hospital and Hypospadias Foundation

Contact us:

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

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India
MITR Clinic: C1/8 Ground floor, Sector-2, VashiCall

Call for appointments: +91-2227743558/ 27744229/ 39/69 and +919324180553.

Or you can fill up this form- Contact form for Dr Singal

January 01 2020

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 30^th October 2019-1^st 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 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.

April 04 2015

Long journey from Patna to Navi Mumbai: Severe scrotal hypospadias managed successfully at Hypospadias Foundation

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.

Happy family with Dr Singal after Surgery

The family sent us some pictures in the healing phase over next few months and the second stage urethroplasty was planned after 6 months of first hypospadias surgery. When we saw the patient again – the flaps and the skin on the underside was very well healed and ready for second stage. Second stage urethroplasty was done and it took just 2 hours for the surgery. The catheter was removed after ten days and the R.P. passed urine in a good stream from the tip of the penis like a normal boy. Family was delighted and after another follow-up visit one week later they travelled back to Bihar.

According to Dr Singal, “With the experience and expertise, currently we do single stage surgery for even scrotal hypospadias and other complex hypospadias. The only limiting factor is the severity of the chordee. Sometimes in sever chordee we need to apply a cut on the underside of penis to straighten it. In such cases, it is better to do a staged repair. In our experience, two stage hypospadias surgery can have excellent cosmetic and functional results. It also provided a longer penis length by straightening the penis and elongating the underside of penis when chordee correction is done.

About the author:

Dr A.K.Singal is a senior Pediatric Urologist and a renowned Hypospadias expert surgeon in Navi Mumbai, India. Every year he operates more than 200 kids and adults with hypospadias from all over the world and from all over India. Dr Singal has done lot of clinical research and conducted training programs for hypospadias surgery in India. Due to expertise in managing complex cases of severe hypospadias and failed hypospadias operated elsewhere, he is counted as one of the best and top hypospadias surgeons in India.

Dr A.K.Singal delivering his talk at ESPU

About Hypospadias Foundation:

Hypospadias Foundation is World’s first and only organisation dedicated to care and cure of children and adults with hypospadias. Started in 2008 by Dr Singal and Dr Dubey, more than 1000 patients have benefitted from care at the foundation from more than 20 countries. The blessings and goodwill only continues to grow from a single point focus of excellence in hypospadiology. The foundation soon intends to start formal training courses in Hypospadias surgery for international doctors.

To contact us you can

Email us at hypospadiasfoundationindia@gmailcom

Or Call Dr Rajkumar, Coordinator, at +91-9821261448 between 10am-4pm.

Else you can fill up this form: Contact Hypospadias Foundation

Watch video of Scrotal hypospadias surgery repair by Dr Singal

Watch video of Proximal penile hypospadias surgery by Dr Singal

Contact Form for Hypospadias Foundation

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

March 03 2015

In search for a cure for Hypospadias: From Lucknow to Navi Mumbai, India

Hypospadias remains the most common urological anomaly in boys and more than 1 lakh kids are born in India every year with Hypospadias. Majority of these are mild variety like glanular, coronal, distal penile or midpenile hypospadias. Less than 15% of all hypospadias are moderate to severe variety of hypospadias like proximal penile, penoscrotal or scrotal hypospadias. While very mild hypospadias like glanular or coronal without chordee may be left alone without surgery, all other types of hypospadias or those with chordee require hypospadias correction treatment.

There are more than 100 different types of hypospadias surgery techniques described in medical literature attesting to the fact that none of the techniques are perfect or suitable for all types of hypospadias. The hypospadias specialist surgeon needs to be well acquainted with anatomy and various techniques to decide the type of surgery needed in a particular hypospadias case. Subtle variations in anatomy decide the type of technique needed. Hence the decision for each hypospadias is very individualized.

The common techniques in use for primary hypospadias are TIP urethroplasty (Snodgrass repair), Mathieu repair, Onlay Island flap urethroplasty, Prepucial tube and staged Bracka’s urethroplasty. Each technique of hypospadias surgery has its own advantages and disadvantages and case selection becomes very important.

Case: Boy from Lucknow

Master A.C. was born with proximal penile hypospadias in Lucknow. He was advised surgery after one year of age by the doctors in Lucknow. They consulted various surgeons in Lucknow and Delhi but were not satisfied by the approach. Finally, the boy’s uncle who was a scientist in CSIR sent an email to Hypospadias Foundation with all records and pictures asking for an opinion. We advised a clinical examination and a single stage surgery. The family flew to Mumbai and saw us in MITR Hospital, Kharghar where Hypospadias Foundation is located. The penis size for Master A.C. was very small with a stretched penile length of 2 cm and Glans diameter of 11mm. We advised two injections of Testosterone (male hormone) to induce growth of penis at one month interval. After one month of second injection, the glans size increased to 15.5 mm and penis length to 29mm. At this time, we planned a hypospadias correction surgery. A.C. was admitted the morning of surgery and a single stage urethroplasty was done using Onlay Island Flap technique for which Dr Singal is very renowned. The surgery took 90 minutes and the boy was discharged the next morning after hypospadias surgery. The dressing was removed after 5 days and catheter was removed after 10 days. A.C. passed urine well and at one month follow-up was passing urine in a good stream without any issues. The penis has healed very well with an excellent cosmetic result. The parents were overjoyed and sent an email of thanks after one month from Lucknow. Further follow-ups will be via email and phone calls. Patients from across the globe follow-up with us using electronic medium such as email, whats app and skype.

Dr Singal with Family from Lucknow

Testosterone (hormone) injection before Hypospadias surgery

In some cases of hypospadias the penile size may be small and the head of penis (glans) may be very tiny. In such cases it is difficult to repair the hypospadias adequately. We advise testosterone injections in dose of 25mg intramuscular injections two months and one month before surgery. The testosterone injections help in two ways: Increasing the size of penis and glans; secondly the blood supply (vascularity) of the foreskin increases which helps in making a good flap in severe hypospadias. Two doses of testosterone injections do not have any short term or long term side effects on body growth etc. Part of the effect of testosterone on penile growth is reversible but part increase in size of penis is permanent. For us at Hypospadias foundation, we give Testosterone injections for babies where the penis size is less than 25mm or the glans diameter is less than 13-14mm.

Onlay Island flap urethroplasty

Onlay island flap urethroplasty is a type of hypospadias repair surgery where a flap is made from foreskin on the top of penis (dorsal prepuce) and brought on underside of penis. This flap is based on a robust blood supply from dartos tissue of the foreskin (see the video below). Onlay island flap urethroplasty is reserved for severe hypospadias or where the TIP repair is not suitable and the chordee is not very severe. In hands of expert hypospadias surgeons, Onlay Island flap urethroplasty offers best results in repair of severe hypospadias. Dr A.K.Singal is one of the best hypospadias surgeon specialists in India for such surgeries. Dr Singal has been invited at various national and international conferences to showcase his surgical technique (see video below). Every year more than 200 children and adults with primary or failed hypospadias are operated under his team’s care in Navi Mumbai, India.

If your child has a hypospadias and you wish to get in touch with Dr Singal for treatment, you can fill up the contact form below or you can see him at one of his hypospadias clinics in Navi Mumbai or Mumbai. You can also call up Dr Rajkumar, Co-ordinator for Hypospadias Foundation at +91-9821261448 between 9am-6pm to discuss any queries.

Dr Singal’s clinics and Timings

Contact form for Dr Singal & Hypospadias Foundation

See Video of Proximal penile hypospadias repair using Onlay Island flap technique- by Dr A.K.Singal

See Scrotal Hypospadias repair using Onlay Island flap urethroplasty- by Dr A.K.Singal

Contact Form for Hypospadias Foundation

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

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Tag Archives: single stage urethroplasty

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation