Adult hypospadias Archives - Page 2 of 3

April 04 2015

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

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

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March 03 2015

Hypospadias repair surgery in adults: Man from Nepal gets successful treatment at Hypospadias Foundation, Navi mumbai, India

Hypospadias is the most common urological birth defect occurring in upto 1/150 newborn boys, which measures upto almost 100,000 (1 Lakh) new cases every year. While most of the cases are not hereditary or genetic, 6-8% of hypospadias cases have family history of hypospadias or associated genetic disorders. In the current era and in cities, most of these children are referred to pediatric urologists or surgeons in early childhood and receive timely treatment for hypospadias. This was not true 20 years back or even now in many parts of the world. Hence, there are a large number of adults living with hypospadias across the world either unrepaired or some who have failed hypospadias surgery in childhood. In India alone, there are an estimated 5 lakh adults who have either not received hypospadias surgery or have failed hypospadias surgery in their earlier years and their families or they themselves have given up.

Every year, we receive adults from many countries in South East Asia and rest of the world who travel to India to Hypospadias Foundation to find treatment for their Hypospadias problem. Recently, a young man travelled from Nepal for hypospadias treatment. We would like to share the story.

Reaching Hypospadias Foundation:

Mr N.S. was born with hypospadias and was diagnosed soon after birth. Due to lack of knowledge and pediatric urology/ hypospadias specialists in Nepal, his parents could not get him treated for hypospadias in childhood. He grew up to be a smart boy and completed his graduation and got employed with an infrastructure company in Nepal. But somewhere at the back of his mind he had this nagging doubt about treatment of his hypospadias issue. He kept on searching whether he can get treatment with good results for hypospadias at the age of 23 years but no one gave him a satisfactory answer. Finally he contacted Hypospadias Foundation at Navi Mumbai, India- a team of hypospadias surgeons led by Dr A.K.Singal and Dr Manish Dubey. He sent his medical records by email and also some pictures. After an electronic opinion, he finally travelled to Navi Mumbai in September 2014.

Examination:

Mr N.S. was examined by Dr A.K.Singal, Pediatric urologist and expert Hypospadias surgeon in Hypospadias Clinic at Hypospadias Foundation, Navi Mumbai, India. He was found to have distal penile hypospadias with mild chordee. No previous surgery had been done. The midline raphe of the penis was misaligned to one side causing a slight bend in the penis also to one side called penile torsion. N.S. was counselled for surgery as well post-op recovery and underwent distal penile hypospadias repair surgery (urethroplasty) the next day.

Hypospadias Repair surgery:

Since it was a case of primary hypospadias and there was no previous surgery done, the urethral plate was still preserved well. We planned to do a single stage TIP repair (Tubularised Incised plate urethroplasty or Snodgrass repair). The new urinary tube (urethra) was made over 12 Fr silicon catheter and covered with two additional layers for secure healing and prevent fistula. First layer was with corpus spongiosum called spongioplasty and second was with dartos from foreskin on the top of penis. Finally excess foreskin on top was excised imparting a circumcised look to the penis. N.S. was discharged the day after surgery on antibiotics, analgesics (painkillers), antacids and antispasmodics. Additionally a medicine was given to decrease erections temporarily. One week later, we removed the dressing in clinic and finally the catheter was removed on day 10. N.S. had some pain initially on passing urine but within 2-3 days he was passing urine normally from the tip of penis. There was an issue with delayed healing of skin on underside of his penis which finally healed completely in 2 months. He has been passing urine normally and came to see us at 6 months follow-up after surgery this week (18^th March 2015) and was extremely happy with the result of hypospadias repair surgery. He has healed well with a single stage surgery and does not require any further surgery. He is planning to start seeing girls now and get married soon. We have given him a clearance to go ahead with marriage and send him our best wishes from Hypospadias Foundation.

Dr A.K.Singal with adult hypospadias patient from Nepal after a successful outcome

Hypospadias repair surgery in adults:

Longer healing time than children: Though the overall success rates of hypospadias surgery in adults remain good and comparable to hypospadias surgery in children, the healing takes longer. It may take upto 2-3 months for the penis skin to heal fully though one can start passing urine normally in 2-3 weeks.
Longer time for indwelling catheter: We like to keep catheter inside for 10-14 days for distal hypospadias repair in adults and 14-21 days for severe hypospadias repair in adults. This is in to children where most of the catheters are removed in 5-10 days.
Higher risk of infections: Since there is hair growth in penile area and more sweating in adults, the chances of skin infections at hypospadias surgery site is little higher in adults.
Pain after surgery: As adults have night time erections during a certain phase of the sleep, there may be episodes of severe pain during healing phase in first one month. Hence we give medicines to decrease the frequency of erections for 4-6 weeks and stronger pain killers.
Abstinence from sex: We advise abstinence from sex and masturbation for almost 3 months after hypospadias surgery in adults.
Off from work: Since most of the adults are in a job or business, it is important to take atleast 4 weeks off from work before planning hypospadias surgery.
Uroflowmetery: We recommend performing a test called uroflowmetry to check the speed of urine passage at 3 months and one year of surgery to make sure that the new passage is of good caliber.

Conclusion

Though there are challenges in treating adults with hypospadias, but with diligence and dedication very good results can be achieved at Centres of Excellence in Hypospadias Treatment. A good counselling, a thorough OPD consultation are a must before embarking on the surgery to ensure that the adults with hypospadias understand the treatment, results and long term outcomes. This also helps in setting the expectations right after Adult Hypospadias surgery.

About Hypospadias Foundation

Hypospadias foundation is the World’s first and only organisation dedicated to care of children and adults suffering from Hypospadias. Founded by Dr A.K.Singal and Dr Manish Dubey in Nov 2008, more than 700 children and adults have found hope and cure at Navi Mumbai India. Kids and adults travel from all over India and now more than 20 countries to Navi Mumbai for state of art treatment, surgery for hypospadias and best results. The unique teamwork between a pediatric and adult urologist allows adults with hypospadias to gain the best results in treatment of hypospadias. Hypospadias Foundation can be contacted at hypospadiasfoundationindia@gmail.com or +91-22-22743558/ 4229 Oor Dr Rajkumar, Coordinator for Foundation can be contacted at +91-9821261448 between 9am- 5 pm India time.

Or you can fill up this enquiry form: Enquiry Form

Contact Form for Hypospadias Foundation

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November 11 2014

Good results of hypospadias repair surgery in adults even after previous failed repairs

Besides 100,000 kids born in India every year with hypospadias, there are an estimated 5-10 lakh adults living with either unoperated hypospadias or failed hypospadias having complications of Hypospadias surgery. These can be minor issues such as urethral fistula, chordee or suboptimal cosmetic results but a significant number may have major issues such as completely failed hypospadias, urethral diverticulum, hairy urethra, urethra stricture etc. Unable to come to terms with penile deformity, they do not get any hope or assurances from adult urologists or plastic surgeons as this may not be the area of primary interest or dedication for them.

Mr Rajveer Singh, 30 years old man, had a midpenile hypospadias with chordee and was operated by a plastic surgeon in Hissar Haryana 2 years back. After surgery, there was a breakdown of hypospadias repair and he was still passing urine from underside of penis. He was still having a downward curvature of penis (chordee) even after this surgery. Also he had seen hair growing out of urinary opening over last few months. He was very worried as he wanted to get married, hence he wrote to us asking for help. We wrote back asking for detailed pictures on email which would help us in understanding his clinical condition and hypospadias deformity. Finally, we called him to see us at Hypospadias Foundation in Kharghar, Navi Mumbai. He took a flight from Delhi to Mumbai and landed up in my Hypospadias clinic on a Monday evening. On examination, he had a urinary opening much below the head of penis in midpenile region and also a couple of holes (urethral fistula) from where he was leaking urine. More importantly his penis still looked bent due to uncorrected chordee. Lastly the cosmetic outcome was really bad with tags of skin here and there and we could see hair coming out of his urethra due to previous failed improper hypospadias surgery. This results when an undertrained hypospadias surgeon uses hairy penile skin for urethral reconstruction. We counselled Rajveer regarding the surgical plan the first step of which would be excision of all unhealthy skin tissue on underside of penis, chordee correction (straightening of penis) and then decide for the type of hypospadias repair in operation theatre. This would be either a single stage repair using a local flap from hairless penile skin or a staged repair using a buccal mucosa graft. In staged buccal mucosa graft – we first excise all unhealthy tissue and scars of failed hypospadias repair, then take a thin lining from inside of lower lip or cheek and then place it as a graft on underside of penis. Once this graft gains local blood supply from penis tissue, we roll it into a urethral tube typically after 6 months of first stage. We always keep buccal graft as the last option in failed hypospadias as that essentially means multiple surgeries. Hence, we attempt to do a single stage flap repair whenever feasible even in failed hypospadias and hence we shared this intent with Rajveer.

Rajveer was taken up for surgery the next day under spinal anesthesia and first a cystoscopy was done. It showed normal urethra beyond midpenile region and unhealthy scarred hairy urethra with fistulae in the distal penile region. We excised all the unhealthy tissues and then checked for chordee. There was still 30 degrees bend in penis which needed correction by a 12 O’clock non-absorbable stitch on the top side of penis. On rechecking with artificial erection, there was no chordee now. After chordee repair was satisfactory, we analysed the penile skin on the right side of penis. We could see an island of hairless skin which was possibly remnant of foreskin (prepuce). We designed a long flap from this with very good blood supply from the underlying dartos tissue. This flap was used in an onlay fashion to repair hypospadias in a single stage. Finally head of the penis (glans) was also repaired and a catheter was placed to drain urine till the whole repair healed. Rajveer went back to his home town in Haryana after 3 days of surgery and then we arranged for one of my surgeon colleagues in Hissar (Dr Vivek Gupta) to help with post hypospadias surgery care. The catheter was removed on day 14 since it was a major hypospadias reconstruction. Rajveer passed urine well and but the full healing of the penis took about 4 weeks. The final cosmetic result was excellent when he sent the pictures via email. He visited us recently almost 3 months after surgery, the penis looked well healed and he is passing urine well from the tip in a good stream. His erections are straight and he is now looking forward to get married. The only question is whether he will invite me for his wedding or not and if he invites, how will he introduce me.

When such complex failed cases do well after hypospadias treatment at Hypospadias foundation, it makes us very happy. We feel our goal of starting the foundation in Nov 2008 has been fulfilled. Last six years have been a long and exciting journey but is has been a very challenging time. When we started we never knew the burden of problem was so high. Along the way we have been privileged to be a part of lives of more than 600 kids and adults with Hypospadias from all over India and some countries abroad. Almost 25% of those receiving treatment at Hypospadias Foundation, have been patients with failed hypospadias who received surgery elsewhere. Though initially we started only with management of hypospadias in children but we realized that there is huge gap when it comes to treatment of hypospadias in adults. Along with Dr Manish Dubey, my close friend who is an adult urologist we are able to offer good care and success rates in adults and failed hypospadias.

In last three years, Hypospadias Foundation has welcomed many patients from many other states and countries such as Nepal, Bangladesh, Greece, Afghanistan, Iraq, Saudi Arabia, UAE-Dubai, Oman, Great Britain (UK), USA, Nigeria, Tanzania, Kenya, Congo, Zambia and this number continues to grow attesting to our devotion to the field of Hypospadias. Within India, kids and their families have travelled for treatment of hypospadias from Assam, Kolkata, Orissa (Puri, Bhubhaneshwar), Ranchi, Chattisgarh (Raipur, Katni), Gujarat (Ahmedabad, Surat, Baroda, Gandhinagar), MP (Indore, Bhopal), Himachal, Delhi, Haryana (Hissar, Rohtak, Panipat), Rajasthan (Bikaner, Jaipur, Jodhpur), Maharashtra (Jalgaon, Pune, Aurangabad, Nasik, Nagpur, Parbhani, Dhule, Solapur, Kolhapur, Ahmednagar, Ratnagiri), Uttar Pradesh (Lucknow, Allahabad, Meerut), Goa, Andhra Pradesh (Hyderabad, Belgaum, Guntur), Uttarakhans (Dehradun), Jammu, Kerala (Cochin), Tamilnadu (Chennai, Salem, Coimbatore) and Punjab (Chandigarh, Ludhiana and Patiala).

About the author:

Dr A.K.Singal is a Pediatric Urologist and Hypospadiologist practicing in western india in area of Navi Mumbai and Thane. He is counted as one of the best hypospadias expert surgeons in the world and every year manages more than 200 kids and adults with hypospadias. He is available at the following clinics :

Clinics and Appointments for Dr Singal

To send an enquiry to Dr Singal’s team please fill up this form: Contact Dr A.K.Singal

Watch video of Single stage repair surgery of severe hypospadias by Dr A.K.Singal

Watch video of repair of glanular hypospadias with chordee by Dr A.K.Singal

Watch video of Distal penile hypospadias repair surgery by Dr A.K.Singal

Contact Form for Hypospadias Foundation

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January 01 2014

Living with Hypospadias- Adults with hypospadias

The tale of hypospadias does not stop in first few years of life for everyone. This is especially true of adults and adolescents who underwent hypospadias surgery repair using older techniques and with lesser trained Hypospadias surgeons 15-20 years back. While a majority of these have done well, there is a sizable population of adults in India who have persistent issues secondary to hypospadias such as urethral fistulas, persistent penile chordee (bending of penis), urethral stricture or bad cosmetic outcome. As Pediatric urologist and a surgeon with deep interest in hypospadias (hypospadiologist), we keep seeing such patients on a regular basis now.

There are atleast estimated 5 lakh adults/ adolescents in India with untreated, complicated or residual issues of hypospadias in India. Some of these people live an unsatisfied life thinking that no cure is possible because that is what they have been brought up to think. Individuals who have failed multiple surgeries are called Hypospadias cripples in medical community signifying the crippling effect which inadequately treated hypospadias can have in a person’s life.

Fortunately, with newer techniques, better hypospadias surgery instruments, very good sutures like PDS, availability of dedicated hypospadias surgery teams and expert hypospadias surgeons good results are possible in any patient with previous failed hypospadias surgery even in hypospadias cripples.

Here is story in point:

Six months back I saw Mr RK, a 30 year old young man, who had been a case of failed hypospadias – operated for hypospadias twice in his childhood in a hospital in Delhi. Both the surgeries had met with partial success and his parents had left him like that and lost hope at a completely functional urethra. RK had been a good student and went on to do Engineering graduation from IIT and then a MBA from Pune. He had taken up a job in multinational company and now was planning to get married. Infact, he had delayed marriage inspite of a successful career because he was never satisfied with outcome of his hypospadias surgery. That’s why he looked up on internet and came to see us at Hypospadias Foundation in Navi Mumbai.

At the first consultation itself and being in relatively the same age group, we hit it off really well and he was quite frank and objective about his condition and that kind of interaction helps a hypospadias specialist like me. When I examined him, he had a persistent mild chordee but the bigger issue was his urinary opening (meatus) was not on the tip of penis (glans penis) but way down in distal penile location. He had many skin bridges and scarred islands of skin and a large urethral fistula in proximal penile region. There was a bit of penoscrotal transposition as well. On questioning, he was passing 50% of the urine from the urethral fistula and 50% from the distal penile location without any straining and in good urinary stream. None of these problems were major by themselves and could have been cured easily but after two failed hypospadias repairs in childhood, I think parents just gave up hope.

So we discussed with RK at length about the various things which needed to be done-

Distal urethroplasty using flap from nearby ventral penile skin,
Closure of urethral fistula (fistula repair) in multiple layers with tunica vaginalis flap
Correction of penoscrotal transposition
And chordee correction by dorsal plication.

The surgery was done next week at MITR Hospital & Hypospadias Foundation. Dr Manish Dubey, Urologist and Co-founder of Hypospadias Foundation helped me with the surgery and management immediately post surgery. RK was sent home the day after surgery. A follow up visit for hypospadias dressing removal was planned on day 5 and catheter removal o day 10.

Some of things especially in adults undergoing hypospadias surgery, which we took care of to ensure smooth recovery and are different from children:

Postoperative pain and erections
Choosing the right urethral catheter and drainage bag

We were also worried about higher chances of wound infection and bleeding after redo-hypospadias repair. For pain and prevention of erections we gave benzodiazepine derivative tablets and phenobarbitone along with diclofenac and that helped pretty well for two weeks. For the catheter, we used a Foleys silicon catheter for 10 days and left it to drain in a urine bag which RK could carry with him and walk around within his home.

Fortunately, everything went well and now after 3 months of hypospadias surgery, the hypospadias surgery site is healing well and there is no more pain during erections. The urine stream is good and RK is passing from the tip of his penis for the first time in his life standing like a normal man. He is not shy to use the public toilets anymore- He just stands up and delivers.

We have asked him to wait for three more months before planning marriage and these three months he is actually going to spend in finding the right girl for himself. For him, we hope the chapter of HYPOSPADIAS is closed now.

The only question remains whether as a Hypospadiologist I will get invited to his marriage- if yes, how will he introduce me? As the doctor who fixed his penis? I think that is too much and I will just skip attending his marriage and I wish him the best of luck always from our side and from everyone at MITR hospital and Hypospadias Foundation in Navi Mumbai, India.

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Category Archives: Adult hypospadias

Contact Form for Hypospadias Foundation

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