Dr. A.K.Singal, Author at Hypospadias Foundation

May 05 2015

Cashless or Mediclaim Coverage of Hypospadias repair surgery and treatment by Insurance Companies in India

Hypospadias is a urinary birth defect in which the urinary opening is on the underside of penis rather than being at the tip of the penis. In more than 50% of patients with hypospadias, the penis is also bent downwards – this penis curvature is called chordee. Hypospadias affects 1/150 newborn boys and hence more than 1 lakh (1,00,000) kids are born in India with hypospadias every year. Worldwide the incidence has increased probably due to increasing burden of chemicals and pollutants which act as endocrine disruptors (chemicals which block male hormone action) and have contributed to an increasing incidence of hypospadias.

Most of these kids except the ones with very minor glanular hypospadias without chordee will need surgery. The surgery is ideally done between 6months-18 months for age of the child was born with good weight and full pregnancy, if the child is underweight or preterm or has any other major anomalies then it may be better to wait till the child is about 3 years of age.

When and how does hypospadias happen?

Hypospadias results from defective formation of urinary tube during 8-12 weeks of pregnancy and hence if there is an interference with penis development after 12 weeks of pregnancy, hypospadias cannot happen as penis formation with urinary opening at tip is complete by 12 weeks of pregnancy. Between 8-12 weeks of pregnancy, the urinary pipe forms under the penis from the base to the tip under influence of testosterone and dihydrotestosterone. Along with the urinary tube the various covering layers of the penis such as spongiosum , bucks, dartos and skin also also formed. Hence when the urethra remain short of tip, all surrounding layers also become short.

Is Hypospadias repair surgery covered by insurance companies or corporates for cashless treatment or re-imbursement?

Hypospadias being a penis birth defect is classified as an external birth defect which can be easily diagnosed as soon as the baby is born. Hence, if parents take an insurance policy after the baby is born, hypospadias surgery treatment costs are not covered by most of the insurance companies in India atleast while in USA, UK it is covered under insurance benefits.

The situation is different for some of the corporate insurance group policy holders. Some big corporates like TCS, Reliance, L & T, Siemens etc issue very employee friendly mediclaim policies which cover all medical and surgical treatments for the employees and their families. Such mediclaim policies cover all pre-existing as well as birth defects for their employees and hence hypospadias repair procedure may be covered by the insurance company by some of these companies.

If insurance does not cover the hypospadias treatment, how much does it cost for Hypspadias repair surgery?

If the insurance company is not covering the treatment, then the parents will have to pay the full charges themselves out of their own pocket. For new parents working in a job or middle class environment this may be financially stressful. What really helps is that Hypospadias repair surgery is a planned procedure. It can be done anytime between 6 months-15 months of age giving parents enough time to rally around and arrange everything from money to other resources. The cost of hypospadias repair surgery depends on the type of hypospadias, complexity of repair, which hospital as well as which type of room one chooses to stay in hospital. On a ball park figure it may wary from 75000 Indian rupees for a minor hypospadias surgery in Hypospadias Foundation to even 3,00,000 Rupees for a complex severe hypospadias surgery in a single deluxe room. Hence, it is best that they meet a hypospadias expert or a pediatric urologist early on in first 3 months of baby’s life and then learn everything about the cost of hypospadias surgery, hospital stay, pre-hypospadias surgery tests and then get mentally prepared for the actual surgery.

About Hypospadias Foundation, Navi Mumbai, India

Hypospadias Foundation is an organisation started by Dr A.K.Singal and Dr Manish Dubey for caring, education and research in field of Hypospadias. Dr Singal is one of the best Hypsoapdias Surgeons in India. The team operates more than 200 children and adults every year with best results in hypospadias treatment. The Foundation operates as a part and parcel of MITR Hospital in Kharghar area of Navi Mumbai. MITR Hospital has cashless and mediclaim tie-ups with all major insurance companies and TPA’s to facilitate cashless treatment of hypospadias if the insurance policy covers it.

If you or your child has hypospadias and need to know more, please write to us at hypospadiasfoundationindia@gmail.com or fill up this contact form

Contact form for Hypospadias Foundation

Watch Videos on Hypospadias Channel by Dr A.K.Singal

Video of Distal penile hypospadias repair surgery

Video of Proximal penile hypospadias surgery

Video of Scrotal hypospadias repair

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)

April 04 2015

From Dhaka, Bangladesh to Navi Mumbai, India: In search for a cure – Story of Adult hypospadias repair surgery

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/

Dr A.K.Singal during Hypospadias surgery

To get in touch with us please write to hypospadiasfoundationindia@gmail.com or fill up this contact form: Contact Hypospadias Foundation

Videos of Hypospadias repair surgery by Dr A.K.Singal

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

April 04 2015

What is chordee (bent penis) and why do hypospadias have chordee? How is chordee correction surgery done?

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:

Dr A.K.Singal during Hypospadias surgery

Dr A.K.Singal is a renowned Pediatric urologist and is one of the best & most experienced hypospadias surgeons across India and world. His deep interest, research, knowledge has helped hundreds of children and adults with hypospadias achieve a satisfactory cosmetic and functional results of hypospadias. Dr Singal is available in Fortis Hospital in Mulund Mumbai, Jupiter hospital in Thane, Fortis Hospital in Vashi (Navi Mumbai) and MITR Hospital & Hypospadias Foundation in Kharghar, Navi Mumbai, India. To reach him you can send him an email at hypospadiasfoundationindia@gmail.com or fill up this form:

Contact form for Dr Singal

Also, you can call up Dr Rajkumar, Dr Singal’s assistant and Coordinator of Hypospadias Foundation on +91-9821261448

Video of Glanular Hypospadias with chordee surgery repair by Dr A.K.Singal

Video of Distal penile hypospadias repair procedure by Dr A.K.Singal

Video of proximal penile hypospadias repair surgery procedure by Dr A.K.Singal

Video of scrotal hypospadias single stage repair procedure by Dr A.K.Singal

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

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