A boy with severe hypospadias – Transverse Island Onlay Flap urethroplasty

S.J., an 8-month-old baby, was brought to Dr. A.K. Singal’s Hypospadias clinic with an abnormal-looking penis and passage of urine from the underside of the penis, almost near the scrotum. On examination, he was diagnosed with a condition called Penoscrotal Hypospadias with mild chordee (an abnormality where the penis is bent downwards). The baby was planned for a corrective hypospadias surgery called SINGLE STAGE URETHROPLASTY, which can be done by multiple techniques, including the Transverse Island Onlay Flap urethroplasty. This technique is particularly suited for cases like a boy with severe hypospadias.

The exact technique in this case was a long Tranverse Island flap urethroplasty. This is the appropriate age (6-9 months) for such surgeries as the final results are very good both cosmetically and functionally at such a young age.

The baby was taken up for surgery and he required only one day stay in the hospital. The dressing was removed on day5 and the catheter on day12.

At 3 months follow-up he has a normal looking circumcised penis with a urethral opening at the top of the glans

A boy with severe hypospadias

Clinical picture showing a penoscrotal hypospadias

A boy with severe hypospadias

Urethroplasty in progress, chordee correction done

A boy with severe hypospadias

Transverse Island Flap has been mobilized based on dartos tissue and reliable blood supply from the dorsal prepuce.

A boy with severe hypospadias

Completed urethroplasty with Special Silicon catheter for diaper drainage

Facts about Hypospadias

  • Hypospadias is one of the most common pediatric urological anomalies worldwide.
  • The correct age for hypospadias repair surgery is between 6-9 months.
  • Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex development, a two or a three stage hypospdias repair may be required.
  • The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
  • Most common problems after hypospadias surgery procedure (5%) are infection and formation of a urethral hypospadias fistula requiring a second surgery.

Hypospadias with thin urethra – Transverse Island Onlay Flap urethroplasty

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis (Coronal Hypospdias) and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hyoplastic urethra. These types of hypospadias may deceptively look mild as the thin distal urethra often needs to be excised and the hypospadias becomes a severe one. The child was planned for a single stage hypospadias repair by Dr A.K.Singal (Hypospadias Specialist)

During hypospadias surgery, hypoplastic urethra was excised and the penis was straightened (chordee reapir). A flap was made from the excess skin on the upper side of penis – this technique of Single Stage Urethroplasty is called Transverse Island Flap Urethroplasty. The flap was rotated towards the underside of penis for making a new urinary pipe. The baby was discharged the next day after surgical correction of hypospadias and double diaper was used for draining the catheter.

Dressing was removed five days after single stage urethroplasty and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis indicating a successful hypospadias surgery

Hypospadias with thin urethra

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Hypospadias with thin urethra

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Hypospadias with thin urethra

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Hypospadias with thin urethra

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Facts about Hypospadias

  • Hypospadias is one of the most common anomalies worldwide.
  • The correct age for corrective surgery is between 6-9 months.
  • Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
  • The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
  • Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery.
  • Link to Hypospadias foundation
  • Link to FAQ’s about hypospadias

A boy with distal penile hypospadias – Snodgrass urethroplasty (also called Tubularised Incised Plate urethroplasty)

A.S., 9 months old child was brought with abnormal curvature of penis and abnormal urinary opening- a condition called hypospadias (means urinary opening on downside of penis). The abnormal curvature is called chordee. On examination – urethral opening was situated on the underside of penis (Coronal Hypospdias) and the terminal part of urethra was very thin and abnormal for whole length of penis. This is called hyoplastic urethra. These types of hypospadias may deceptively look mild as the thin distal urethra often needs to be excised and the hypospadias becomes a severe one. The child, a boy with distal penile hypospadias, was planned for a single stage hypospadias repair by Dr A.K.Singal (Hypospadias Specialist).

During hypospadias surgery, hypoplastic urethra was excised and the penis was straightened (chordee reapir). Incision was given in the urethral plate in the midline and urethroplasty done which is called Tubularized Incised Plate Urethroplasty. The baby was discharged the next day after surgical correction of hypospadias and double diaper was used for draining the catheter.

Dressing was removed five days after single stage urethroplasty and the catheter was removed after 10 days in clinic.

At 3 months follow-up the penis has healed well and now looks like a normal circumcised penis indicating a successful hypospadias surgery.

Distal penile hypospadias

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Distal penile hypospadias

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Distal penile hypospadias

Penis after degloving and excising the thin distal urethral wall -actually a severe hypospadias

Distal penile hypospadias

Clinical Picture showing thin urethra with opening just below the tip of penis- deceptively mild hypospadias

Facts about Hypospadias

  • Hypospadias is one of the most common anomalies worldwide.
  • The correct age for corrective surgery is between 6-9 months.
  • Most of the hypospadias can be corrected with a single stage surgery, rarely if the penis is too curved (chordee) or the skin is short or there is an associated disorder of sex differentiation, a two or a three stage surgery may be required.
  • The success rate of Single Stage Urethroplasty in correctly chosen cases is more than 95%.
  • Most common post-op problems (5%) are infection and formation of a fistula requiring a second surgery.
  • Link to Hypospadias foundation
  • Link to FAQ’s about hypospadias

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