Hypospadias remains the most common urological abnormality affecting more than 1 lakh kids in India alone (based on incidence of 1/150 in newborn boys). Leaving aside very minor hypospadias without chordee- almost 70-80% of these require hypospadias treatment in form of repair surgery in early childhood.
For a child with Hypospadias, the first surgery is always the best surgery but still there can be complications and failure even in expert hands though complications are much less if operated by a surgeon or a centre where there is a focused practice in treating children with hypospadias. Literature and experts suggest that if a hypospadias surgeon is doing more than 50 hypospadias repairs in a year, then his results will be better and more predictable as compared to a general pediatric surgeon or a urologist who does only 10-20 hypospadias repairs in a year. Once a hypospadias surgery fails, then the next surgeries become more difficult and result more unpredictable. The failure rate of hypospadias surgeries vary from 5% to 50% depending on the type and severity of hypospadias in general centres and less than 10% in centres where hypospadias surgeries are done by expert hypospadias surgeons on a day to day basis.
Case details
Master A.P. was born with a distal penile hypospadias and underwent first surgery in Ahmedabad at the age of 6 years. Unfortunately, the surgery failed and he started passing urine from the same place on the underside of penis- a fistula. The new urinary passage through the head of the penis got tight and closed off. The surgeon tried to open it many times by catheter insertion but it failed. Coupled with failed hypospadias, the child also had an unsatisfactory cosmetic appearance in form of bunching of skin on underside of penis. With this situation they contacted Dr A.K.Singal, Pediatric urologist and expert Hypospadias surgeon at Hypospadias foundation in Kharghar, Navi Mumbai when the boy was ten years of age. After examining and confirming that the whole urinary pipe will have to be remade from distal penile region to the tip of penis (glans), Dr Singal advised a Onlay island flap repair for which the flap would be raised from the nearby bunched up skin. This repair is technically challenging because of previous failed hypospadias surgery but this was the only chance for the boy to have a single stage repair. The surgery for failed hypospadias was finished in 2 hours and A.P. was ready for discharge the next day but since they had travelled all the way from Gujarat, they decided to stay for 7-8 days in Navi Mumbai. The catheter was removed on day7 and he passed urine well from the tip. For the first one month after surgery, there were some chances of new opening getting tight, hence we taught the boy to insert a small catheter just 1cm into the new opening with an antibiotic ointment. The penis healed well in next 3 months and he has remained free of all symptoms now for last 5 years. At 15 years of age and after his 10th standard exams, A.P visited us and had a big smile on his face. He is looking forward to higher education and he shared with us his dreams and further education goals. We plan to see him again one last time at 18 years of age. His penis growth and his functional & cosmetic outcome has been excellent so far.
Dr A.K.Singal with the patient
Letter of thanks from the father:
Dear Dr Singal,
My son A.P was operated first at Ahmedabad. The hypospadias problem was not solved and it actually worsened and we were very tense my son’s future life. While searching through internet I came to know about you and your colleague doctors.
From your past surgeries and mastery about Hypospadia surgeries we decided and contacted you before surgery. At Mitr hospital, from the first meeting with you, we were confident about our son’s second Hypospadias surgery and we decided to do it only with you.
At Mitr Hospital, we experienced very good pre and after surgery treatment from Doctors and staff also, very good and polite staff. At Gujarat we don’t have such experienced and professional hospital staff. I think this is also very important besides doctors. I feel that if the doctors are not confident they must not try and go ahead for these type of surgeries because once it is fails, the situation of patient and his family is unbearable. It creates psychological problems also and these can be very stressful to handle. Thanks to your team, my son is doing well now.
Regards
M.P., Gandhinagar, Gujarat.
About Failed Hypospadias repair:
When the hypospadias surgery fails, it is a moment of distress and lot of anguish for the parents. Even the doctors feel terrible because they know that even a hypospadias surgery which has been done well doesn’t mean that everything will heal also well. There are many variable factors which affect healing and hence, complications of hypospadias surgery happen sometimes even in best of hypospadias surgeon’s hands. The only difference being that when an expert hypospadias surgeon does the surgery, the chances of complications decreases drastically. And even if the complications happen, they can be managed well without any panic or long lasting impact.
The complications which may need second surgery are: urethral fistula, tight urethra (stenosis or urethral stricture), residual curvature (chordee), dehiscence (complete breakdown or partial breakdown), diverticulum, penile torsion or an unsatisfactory cosmetic outcome. Once it is ascertained that a second surgery is indeed needed for hypospadias, it is important to wait for 5-6 months before planning the next surgery.
About Dr A.K.Singal
Dr A.K.Singal is a well known Pediatric Urologist and one of the best hypospadias surgeons in India. Every year under his care in Mumbai, Thane and Navi Mumbai, more than 150 children undergo hypospadias treatment. More than 50 of these are children who have failed hypospadias surgery done elsewhere. With his deep understanding and experience, Dr Singal and his team are able to offer care and cure to these children. He can be contacted at hypospadiasfoundationindia@gmail.com or you can call his Assistant Doctor – Dr Rajkumar at 98212161448 if you wish to take a second opinion for a failed hypospadias surgery. Else you can fill up this contact form:
Contact Dr A.K.Singal