Single stage hypospadias repair in a child with distal hypospadias after circumcision

Single stage hypospadias repair in child, 18 months boy was brought to us with complaints of spraying of urine from the distal penile region. Hypospadias was missed at birth, and he underwent religious circumcision in infancy.

He visited to our OPD for an expert opinion. Meatus was at the distal penile region and was very wide like a megameatus (megameatus variant) with short penile skin both ventrally and dorsally. He was planned for single stage repair for his distal hypospadias. We anticipated some difficulty as the penile skin was short and in such cases second layer coverage over urethroplasty becomes difficult.

Pic 1: Stay stitch taken over the glans and marking done.

Stay stitch was taken over the glans using 5-0 prolene. Marking was done. Local anaesthesia (lignocaine with adrenaline) was infiltrated at the marked site. Penis was degloved completely. Chordee was assessed after deep degloving and no chordee was noted. Glans wings were widely raised. Tubularization of distal urethra was done in a continuous fashion with 6-0 PDS. Second layer was closed using local tissues with 6-0 PDS. Dorsal skin was divided in the midline and dartos flap harvested from the right half and sutured over the urethroplasty using 6-0 PDS. Skin was closed on dorsal and on the ventral side.

Pic 2: Deep degloving, chordee assessed and no chordee noted.

Pic 3: Distal urethroplasty done and result after completion of the repair.

Pic 4: Urine stream after catheter removal

Hypospadias repair after circumcision

Every neonate should have a proper genital examination at birth by a qualified pediatrician or a neonatologist. This ensures that hypospadias is not missed at birth. Even then some variants of hypospadias may be missed at birth such as glanular hypospadias, MIP (megameatus intact prepuce) variant and chordee without hypospadias. If such variants are missed and a religious circumcision is performed, then future repair becomes challenging.

Hypospadias is generally associated with deficient penile skin ventrally and excess foreskin dorsally.  Foreskin is required for urethroplasty in children with poor urethral plate and shallow glans groove and for skin closure in hypospadias. We also use dartos tissue from dorsal excess skin and provide a second layer to urethroplasty so that we can decrease the chance of fistula formation. In children who have undergone circumcision, dartos flap is unavailable to cover the urethroplasty in hypospadias repair surgery.

During circumcision, it is necessary to retract the foreskin completely and check for the position of the meatus. Any surgeon performing the circumcision in a child should be vigilant and circumcision should be avoided at all costs in children with hypospadias.

If you are planning circumcision for your child or if you have doubt that there may be hypospadias and chordee, then visit a specialist pediatric urologist before planning the procedure.

At Hypospadias foundation, our specialty hypospadias hospital, we get children from all over India and from more than 25 countries all over the world in search of cure for hypospadias. At our centre we treat adults and children after multiple previous unsuccessful surgeries. Our experience clearly shows that previous circumcision makes subsequent hypospadias repair surgery difficult.

Dr A K Singal is a highly experienced surgeon and is regarded as the best hypospadias surgeon in India and in the world for treating children and adults with hypospadias. If you are looking for a highly skilled and experienced pediatric urologist and hypospadias surgeon for yourself or your child, then Dr Singal is an excellent choice.

Dr Ashwitha Shenoy is an expert pediatric surgeon with a special interest in pediatric urology and hypospadias. Dr Singal and Dr Shenoy’s collaboration allows them to offer advanced surgical techniques and comprehensive care for patients.

If you or your child has hypospadias and you wish contact Hypospadias foundation, you can contact us by following methods:

Contacting the Hypospadias Foundation:

• Website: https://www.hypospadiasfoundation.com/
• Email: hypospadiasfoundationindia@gmail.com
• Phone:
  • +916262840940
  • +916262690790
  • +919324180553(whatsapp and teleconsult)

Fill up contact form: https://www.hypospadiasfoundation.com/contact/

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