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June 06 2015

Letter from Australia makes our day and life worthwhile: Infant with scrotal hypospadias gets operated successfully in one stage in India

Hypospadias is a common urological anomaly and fortunately most of the hypospadias are distal or midpenile in variety with good results in one stage surgery. Scrotal hypospadias are the most severe forms of hypospadias where the opening in far behind in scrotum, in between the testicles. 6 months back we treated a child with hypospadias who travelled with his family all the way from Australia for a hypospadias repair surgery. But the story actually started as soon as the baby was born. The family had contacted us for an email and telephonic consultation and we were there with them from the neonatal age till the surgery and the care continues electronically even now.

Fortunately, with meticulous pre-surgery planning and good support we could get a good result of the surgery in one stage itself. The child is doing very well now and doesn’t look like that he will need any further hypospadias surgery. The family was overjoyed and they have sent us an email now (6 months after surgery) and we were all very happy to read the email. It made our day and also made the whole purpose of starting Hypospadias Foundation worthwhile.

We have taken the liberty of using most of the email in an unedited format here after seeking due permission from the family.

Hi Dr. Arbinder Singal,

How are you?

Please find below what we truly felt. Also as discussed, we would not prefer either our or or son’s name to be reflected in the recommendation, however please feel free to provide my details to parents who are in a similar situation and need help just like we did when our son was diagnosed with severe hypospadias.

First News

It all started on 2^nd December when my son was born in Sydney (Australia), it was the happiest moment of my life but I didn’t know that it will last only for the next 24 hours.

The next morning, as a usual process in Australian Hospitals, Specialists came to check my son and called me. The specialist checked my son and without any emotions or sympathy or even empathy told me that my son is suffering from Hypospadias and that too a severe one and it will take at least 2-3 operations period. My ears were striving hard to hear that after those operations it will be completely cured and everything will be fine but the doctor told me that the Hypospadias is severe and there is no guarantee and gave me an information booklet with scary after operation images. As far as I remember I asked him thrice may be more that whether my son would be alright after those operations? yearning for an answer that “everything will be alright” may be a pat on my shoulder to give me some strength or courage to deal with the situation but he left without saying even a single positive word.

I could barely walk after that conversation, everything around was meaningless and sad. My wife was still in the hospital recovering from the caesarean operation, I chose not to tell anyone in my family and let them be happy. I came home that night as you are not allowed to stay in the hospital in Australia. I was not able to sleep that night and the next morning while I was still at home, all my emotions came out, I couldn’t stop the tears and my family came to know about it and tried to give suggestions but that doctor had filled my whole system with so much negativity that I believed that there is no solution and my son will never be cured. After venting out my emotions, I started researching about Hypospadias specialists in the world and I found Dr V.R.Jayanthi and called his clinic in U.S.A but he was not available. I did some more research and found Hypospadias foundation in Navi Mumbai, India. Honestly I didn’t care to read the content on the site and went directly to the contact us page as I was so desperate to talk to a specialist and got through Dr. A.K. Singal’s clinic and fortunately they helped me to set up an telephonic appointment with him.

Half an hour Conversation changed everything!

Carrying a huge backlog of negativity, I called up Dr. Arbinder Singal. The conversation started with a lot of questions and Dr. Arbinder Singal listened to all my questions and concerns patiently and irrespective how silly the questions were, he answered to every question in detail. Honestly that conversation changed my life and in particularly one sentence from him – “THERE IS NO HYPOSPADIAS WHICH CANNOT BE CURED”. He guided me to contact a pediatric endocrinologist right away and explained in detail on how to proceed with the next steps. I recorded that conversation and told my wife about the news because now I had the solution – Dr. Arbinder Singal!

A Close shave

I am really thankful to Dr. Arbinder Singal for recommending a pediatric endocrinologist at that point. I want to again emphasize here that everyone apart from Dr. Arbinder Singal missed an important step in the journey – Meeting a Pediatric Endocrinologist.

As per the paediatric endocrinologist – Dr. Andrew Biggin (he is still my son’s paediatrician and has agreed to mention his name) there were some injections which needed to be given to my son before a certain age which we would have definitely missed as no other Doctor asked us to meet a paediatric endocrinologist. We communicated a lot with Dr. Arbinder Singal updating him about the progress and again asking questions to which he patiently responded every time. He also helped us to get in touch with the other parents whose children had undergone hypospadias repair surgery under his care which helped a lot as they explained us how they went through the treatment and journey. We are really thankful to those parents as well as every time we had an emotional breakdown or we felt nervous they acted as a big emotional support and had long conversations calming us down. Finally Dr. Arbinder Singal helped us decide a date and hospital for hypospadias operation.

The Surgery..

We travelled to India for surgery and we arranged a villa near Fortis Hospital in Vashi, Navi Mumbai and went to meet Dr. Arbinder Singal for the first time in Mumbai. After our meeting the comfort level and confidence increased multi-fold, he was very nice to speak with and inculcated the same confidence in us. He checked my son and said he will try to do it in one operation itself. We had already booked a room in Fortis and admitted my son for the surgery. We met him again before the hypospadias operation, we were nervous but we were calm as we knew that our son was in safe hands. All the hospital staff was very helpful on the operation day and Dr. Arbinder Singal gave us the good news that the operation is successful and my son would not need another surgery.

Highly Highly Recommended!

I would highly recommend Dr. Arbinder Singal as he is an hypospadias expert and good human being. He is reachable and understands the emotions & nervousness which the parents go through. All the more the issue which all the doctors in Australia could solve only by doing multiple hypospadias surgeries, he did that in one go with a single stage hypospadias repair.

I and my family are and would be really thankful to him for forever.

Thanks Dr. Arbinder Singal & Hypospadias Foundation!!

Regards,

A happy kid and his family

Sydney, Australia

About Hypospadias Foundation and Dr A.K.Singal

Hypospadias Foundation is an organisation dedicated to care & cure for patients children and adults suffering from Hypospadias and DSD (disorders of sex development). It is located within a boutique Urology centre – MITR Hospital in Kharghar, Navi Mumbai, India (www.mitrhospital.com ). Hypospadias Foundation was started in 2009 by Dr A.K.Singal and Dr Manish Dubey and till date more than 800 children and adults have been treated at the Foundation from all over India and more than 20 countries (june 2015). The foundation keeps on growing with blessings from families and support from society.

Dr A.K.Singal is a renowned pediatric urologist surgeon and a top hypospadias specialist practicing in Mumbai, India. He is an expert in management of children and adults with hypospadias and is a strong force behind community and medical education for hypospadias. Every year he does more than 200 surgeries for hypospadias and conducts research for hypospadias. For his deep passion and excellent results in hypospadias, Dr Singal is counted as one of the best hypospadias surgeon’s in the world.

Hypospadias Foundation can be reached at hypospadiasfoundationindia@gmail.com or you can call Dr Rajkumar (Coordinator) at +919821261448

Or you can fill up this contact form: Contact Hypospadias Foundation

Watch Video of Scrotal Hypospadias Surgery by Dr A.K.Singal

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

Watch video of distal penile hypospadias operation surgery by Dr A.K.Singal

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)

February 02 2015

Boy from Congo (Africa) finds cure for Distal Penile Hypospadias in Navi Mumbai, India- Successful hypospadias repair surgery even after circumcision

Hypospadias is the most common urological anomaly (birth defect) seen in newborn babies worldwide. It is mostly diagnosed soon after the baby is born when the opening of for urine is seen to be on underside of penis, the foreskin (prepuce) is incomplete on the underside and there may be a bend in the penis (chordee). Very rarely, if the hypospadias is very mild, it can be missed on neonatal examination by even a pediatrician.

Lot of countries and religions practice and advocate newborn circumcision in all male babies but whenever hypospadias is diagnosed in newborn age, circumcision should not be done. During circumcision, the prepuce is cut off and a very vital tissue which is required for hypospadias repair surgery is lost. Prepuce or its layers are used for anatomical hypospadias correction surgery. In a circumcised boy, hypospadias repair becomes difficult and complication rate of hypospadias surgery is little higher.

Master K.Hadriel.Ileunga was born in Congo (Africa) in a small city. His doctor did not recognize at birth that he had a distal penile hypospadias. He underwent a circumcision in the first few days of life by a general practitioner doctor. Later his parents and doctors realized that Hadriel had a distal penile hypospadias. As he grew up in Congo (Africa) his parents worried about his hypospadias. They visited a few doctors in Congo but there was no pediatric urologist available in Congo who could do a hypospadias repair after circumcision. At this time, they learnt about Hypospadias Foundation in Navi Mumbai, India and sent an email to come and get treated under Dr A.K.Singal’s care, one of the most renowned pediatric urologists and the best Hypospadias Surgeon in India.

Finally in first week of Jan 2015, the family met Dr Singal in Navi Mumbai. On examination, Hadriel had a distal penile hypospadias without chordee. There was no prepuce as he had undergone a circumcision in newborn age. After discussing with the parents, Hadriel was taken up for Hypospadias repair surgery on 16 Jan 2015. The surgery was done using Tubularised incised plate urethroplasty – also called Snodgrass urethroplasty. The whole urethroplasty was completed in one stage. The child was discharged from hospital the next day and the hypospadias dressing was removed after 5 days. The urethral catheter was removed after one week of surgery. Hadriel passed urine in very good stream without any difficulty. After a final follow-up two week after surgery, Hadriel has gone back to Africa- his country Congo and family is very happy. Fortunately, he had an excellent result of hypospadias repair surgery even after a neonatal circumcision.

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Watch Video of Single stage surgery for severe scrotal hypospadias by Dr A.K.Singal, Hypospadias specialist surgeon

Contact Form for Hypospadias Foundation

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

August 08 2014

Twins from Greece undergo successful surgery for severe hypospadias in Mumbai, India

Across the borders for Hypospadias

Hypospadias is one of the most common congenital anomalies affecting more than 4,00,000 newborn babies every year across the globe. The problem is not restricted to any particular country or race. Every year, our team at Hypospadias Foundation lead by Dr A.K. Singal manages kids with hypospadias from across India and also from other countries such as Nigeria, Kenya, Iraq, Bangladesh, USA and recently Greece.

Well, the kids from Greece were a whole different story. Though originally from Greece, their father Ioannis Padadatos was employed with a company in Delhi. Master Konstantinos and Spyridon Papadatos, twin babies were born in Delhi to Maria and Ioannis were noted to have hypospadias at birth. The hypospadias was relatively severe in both the children and had associated chordee. The urethral opening was near the scrotum (testis) called Penoscrotal hypospadias. Parents were very hassled as they had never heard of the condition before and now both their newborn babies had severe variety of hyposapdias. Dissatisfied with the information given by pediatricians, pediatric surgeons and urologists in Delhi, they took up to internet for more information. They contacted Dr A.K.Singal, Pediatric Urologist & renowned Hypospadias surgeon who regularly writes articles at www.hypospadiasfoundation.com . Though they had visited the multiple doctors in delhi, what reassured them was the blogs written by dr A.K.Singal about his experience with children who had hypospadias.

After exchange of a few emails, Maria and Ioannis travelled all the way to Mumbai when the babies were 6 months old, in Nov 2013 to consult Dr A.K.Singal at Fortis Hospital in Vashi. Since the right age of surgery for hypospadias is 6 – 15 months, the parents elected to get the surgery done as soon as possible. After the blood tests, the parents again came to Mumbai in December to get the surgery done for both the kids. Master Spyridon underwent surgery on a Monday while Konstantinos underwent surgery on Tuesday. Though both had severe hypospadias and the parents were counseled that a two staged correction may be needed, the whole hypospadias surgical correction was performed in one stage using an Onlay Island Flap urethroplasty of which Dr Singal is an expert. The correction of penile curvature (chordee correction) and formation of new urinary tube (urethroplasty) were all performed in one stage.

After one more day post-surgery in Mumbai, the family travelled back to Delhi and kept in regular touch with Dr Singal via email. Dr Singal visited them one week later in Fortis Hospital in Delhi while attending a conference. Finally the catheter (urinary pipe) was removed after ten days of surgery and babies passed urine in good thick stream signifying a successful outcome in one stage. Now almost nine months after hypospadias surgery, both the babies are doing extremely well.

The family has now shifted to Doha, Qatar but they have taken a lot of India with them and most of all fond memories. We at Hypospadias Foundation are very happy to see the kids grow well and pass urine from a normal opening.

Dr Singal adds “With the advances in instruments and sutures plus better surgical techniques, we are able to do single stage correction for even severe hypospadias in most cases. Rarely we need second surgery and that too if there are complications in the first hypospadias surgery. I am happy that Maria and Ioannis trusted us for management of their children for hypospadias. They came with full faith and trust and that made my job so much easier. I will always remember their family and their beautiful kids. It was indeed a joy meeting them and knowing them. Sometimes I wonder as a hypospadias surgeon what kind of leap of faith the parents must take to travel in an unknown country to an unknown doctor and trust him/ her with the lives of their little ones. I truly appreciate their courage and faith.”

Contact Form for Hypospadias Foundation

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

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Category Archives: Cases worth noting

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation