Hypospadias Surgery Archives - Hypospadias Foundation

May 05 2024

What are the factors influencing success of hypospadias surgery?

Successful hypospadias surgery is a corrective procedure that aims to create a urinary passage with opening at the tip of the penis. The final cosmetic result is such that the child or adult can pass urine in a single straight stream without any pain or discomfort. Any curvature of the penis (chordee) is also corrected during the hypospadias surgery, and this is important for future sexual function.

Most boys who undergo hypospadias repair in early childhood before 5 years have minimal recollection of hospital stay and surgery. The repairs are typically durable and hold up well throughout puberty and adulthood. The success rates vary depending on the severity of the condition, but most studies report a success rate of over 90% for distal hypospadias (mild cases) and 80% for more proximal cases. At hypospadias foundation, we are dedicated in treating children and adults with hypospadias for last 15 years, hence our success rates are more than 95% for mild, severe and redo hypospadias in children and in adults making us a leading centre for hypospadias repair in India and worldwide. Here are some factors that contribute to a successful hypospadias surgery:

Surgeon’s experience : Hypospadias surgery is a specialized procedure, and the success rate is higher when surgery is performed by a surgeon who has experience with this type of surgery. A skilled surgeon with experience in hypospadias repair can create a more natural-looking penis, which can boost your child’s confidence and self-esteem in the long run. Hence a surgeon who performs more than 50 surgeries per year has better success compared to centres which perform only very few per year. At hypospadias foundation we currently perform almost 250 hypospadias correction surgeries every year.
Severity of hypospadias: Generally, milder forms of hypospadias have a higher success rate than more severe forms. Severe hypospadias is usually associated with moderate to severe chordee and mostly needs a staged repair. The risk of complications is also higher in severe hypospadias.
Age at surgery: Hypospadias surgery is typically performed between 6 to 18 months of age or between 3-5 years of age. The results after hypospadias surgeries are excellent in childhood and it also ensures proper development of the penis. Surgery in adulthood is associated with slow healing due to decreased collagen production and decreased cell turnover with age which in turn leads to higher risk of complications. Rate of infections and breakdown is also more in adult hypospadias repairs.
General health of the child: We routinely check hemoglobin, overall growth & wellness of the child, urine for any infection before surgery. Children who are underweight, not growing well, have added anomalies or feeding issues, have higher rates of complications.

During and following hypospadias repair surgery, there are several things that can be done to improve the chances of a successful outcome :

During the surgery :

Choosing the right technique: There are several different surgical techniques used to repair hypospadias. The best technique for a particular child or adult will depend on the severity of the hypospadias and the surgeon’s experience. A hypospadias surgeon should choose the best technique after considering all the factors during the surgery. With more experience, a skilled surgeon can choose a technique which will give good results in a particular case. Experience allows surgeons to anticipate potential problems during surgery and adapt their approach accordingly. They can recognize anatomical variations and make real-time decisions to avoid complications.
Tissue handling: Most of the good results in hypospadias surgeries are attributed to use of right instruments, technique and how gently the surgeon handles the tissues. A skilled surgeon handling a hypospadias surgery translates to better handling of tissues, minimizing blood loss, and precise suturing, all reducing potential complications.

Minimizing the duration of surgery: The longer the duration of surgery the higher the risk of tissue edema and impaired healing. The tourniquet is tied at the base of the penis for some steps to avoid bleeding during the surgery. If the tourniquet time is longer than 30 minutes, then there may be risk of tissue injury and healing may be slower in these cases.
Breathable dressing after surgery: Tight compression dressing can cause pressure on the new urinary passage hence light dressing is advised after hypospadias surgery.
Preventing infection: All aseptic technique and precautions should be followed during the surgery to prevent surgical site infection. Also, a pre-surgery antibiotic should be given to prevent infections.

After surgery :

Dressing care: Hypospadias dressing can get soiled with stools after surgery. Whenever hypospadias dressing gets dirty it must be changed. Soiled dressing is a nidus for infection. Parents must be strictly instructed to keep a close watch and report to the hospital in case of soiled dressing.
Identifying infection at early stages: Fever with foul smelling dressing or pus discharge from within the dressing are signs of wound infection. When present, the dressing must be changed immediately along with administration of intravenous antibiotics to control the infection.
Using prescribed medications as directed: Your doctor will prescribe medicines such as oral antibiotics, analgesics, anti spasmodics, multivitamins etc which will prevent infection at the operated site, give relief from post operative pain and help in healing.
Wound care after dressing and catheter removal: After dressing and catheter removal, hot water bath is advised three times a day. Local antibiotic ointment is applied at the operated site to facilitate healing. Failing to follow these may lead to infection at the operated site, in turn affecting the surgical results.
Feeding & general health: Make sure that the child is taking a nutritious diet, is pain free and happy in the recovery phase. Junk food should be avoided. Constipation should also be prevented by good hydration, fibre rich foods and if need be laxative syrups.

Experienced surgeons would have likely encountered various complications of hypospadias before. This knowledge allows them to identify early warning signs and take corrective measures swiftly, minimizing the severity of complications.

If you are considering hypospadias surgery for your child, it is important to discuss the risks and benefits with a hypospadias specialist. Best hypospadias surgeon is the one who has abundant experience in this field and have likely interacted with many families dealing with hypospadias. This experience allows him/ her to communicate complex medical information clearly and answer your questions patiently, easing your anxieties. An experienced surgeon doesn’t guarantee zero complications, but using proper protocols significantly reduces the risk. Open communication is the key. Discuss your concerns about complications with the surgeon and ask questions openly. By finding a skilled and experienced hypospadias surgeon and openly discussing potential complications, you can ensure best outcome for your child’s hypospadias surgery.

If you are looking for a centre with excellence in hypospadias and dedicated in hypospadias treatment and care, then hypospadias foundation at Kharghar, Navi Mumbai would be one of the choices. We at hypospadias foundation specialize in hypospadias surgery, including complex and redo cases. We recognise the emotional impact of hypospadias and offer counselling support for families. If your child or someone you know is suffering from hypospadias, then do write to us or visit us so that we can help you get the best hypospadias treatment.

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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January 01 2020

Dr A.K.Singal presents his work at Hypospadias World Congress at Childrens Hospital of Philadelphia, USA

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Dr A.K.Singal was an invited speaker at Hypospadias World Congress at Children’s Research Center at Children’s Hospital of Philadelphia, USA, held between 30^th October 2019-1^st Nov 2019. Dr Singal presented four papers on hypospadias treatment and moderated scientific sessions during the conference.

The conference saw participation from more than 150 pediatric urologists and hypospadias specialists from across the world. The conference solely focussed on hypospadias. Various aspects of hypospadias were discussed such as etiology, diagnosis, hormonal tests and supplementation (testosterone injections), surgery techniques and complications/ results of hypospadias surgeries.

Dr A.K.Singal

Dr Singal with Dr Long & Dr Zaontz

Dr Singal presented the following lectures and papers in the World Congress:

Buccal inlay graft for failed hypospadias- Dr Singal showed technique of buccal (oral) mucosa graft inlay surgery and its results in failed hypospadias cases.
Considerations in adult hypospadias repairs- Adult hypospadias are difficult to manage especially if the surgery done in childhood has failed. Dr Singal showed innovative surgery techniques for such adult hypospadias cases for best outcomes.
Reimagined Byar’s flaps for staged hypospadias repairs- For hypospadias with severe chordee, it is important that the penile curvature gets fully corrected in first stage and then second stage surgery is done for bringing the urethra to the tip of penis. In expert hands the results of two stage surgery for hypospadias with severe chordee is very good. Dr Singal showed finer nuances of surgery to achieve best results to the audience.
Parental Awareness survey for families with hypospadias: Families of children or adults with hypospadias are often not fully aware of the extent of disease and what it means in the long run. Dr Singal and his team conducted a study of 150 families to understand about their concerns about hypospadias and their knowledge level about the disease/ surgery.

Overall the three-day conference resulted in great mutual exchange of ideas and also helped younger generation of surgeons learn from eminent faculty from all over the world.

September 09 2018

Hypospadias Foundation starts Clinic in Bahrain

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias surgery is a very delicate, specialised and rare surgery. It requires years of training, very special interest, and dedication to get good results from hypospadias surgery. Often the first surgery is the best hope for cure from hypospadias; once there is a failure at first surgery, subsequent surgeries become difficult and results poorer. Hence, it is recommended that hypospadias treatment should be conducted only by trained pediatric urologists and hypospadias surgeons. To provide such specialized care, the Hypospadias Foundation starts Clinic in Bahrain, ensuring expert treatment for hypospadias patients.

At Hypospadias Foundation in India, hundreds of children come from all over the world to seek treatment either for primary or for failed hypospadias. Children from more than 20 countries have benefitted from surgical expertise and caring attitude of team at Hypospadias Foundation located at Navi mumbai, India.

Many these children come from middle east, Gulf/ GCC countries and MENA region to India. While we get more than 50 enquiries a month from countries such as Bahrain, Saudi Arabia, Oman, UAE (Abu Dhabi/ Dubai), Qatar, Kuwait, Iran, Iraq, Jordan, Kenya, Tanzania, Nigeria – many of them find it difficult to come to India as some of these children may require multiple surgeries if the hypospadias problem is complex or they have failed surgeries elsewhere.

Sensing this acute gap in quality of hypospadias care, Hypospadias Foundation has started a Pediatric Urology and Hypospadias Clinic offering consultations and surgeries in Bahrain. The centre is located at Ibn Al Nafees Hospital in Manama, a renowned hospital with good facility and excellent reputation for good quality care of children.

The Hypospadias and Pediatric urology centre will offer consultations, diagnosis, pre and post-surgery care, surgery for various Pediatric urology disorders including hypospadias. The centre is run jointly by Dr A.K.Singal, Hypospadias Surgeon & Pediatric Urologist from Mumbai, India and Dr Mahmood Abbas, Senior Pediatric Surgeon trained in France and living in Bahrain.

Dr A.K.Singal is considered as one of the best hypospadias surgeons worldwide. Every year he treats kids from all over the world for primary, severe, complex and failed hypospadias. Dr Singal’s experience in Hypospadias surgery is one of the largest single surgeon hypospadias treatment experience in the world.

Dr Singal said,” Every month we receive enquiries via email from children of parents living in Gulf, Middle East and MENA region for hypospadias. It is indeed cumbersome and expensive for them to travel to India for surgery and treatment of hypospadias. Our association with Ibn Al Nafees hospital, Manama, Bahrain will offer them care and surgeries for hypospadias within a more accessible and familiar location in the beautiful country of Bahrain. The centre will also focus on offering treatment for other child urology conditions such as hydronephrosis, reflux, infections, incontinence, undescended testis (cryptorchidism), megaureter and kidney stones.

Dr Mahmood Abbas added, “Myself and Dr Singal have formed a team to start Hypospadias and Pediatric Urology Clinic at Ibn Al Nafees Hospital to ensure that children with hypospadias and pediatric urological conditions get the best treatment. Even children who have failed earlier hypospadias surgery, can be managed with advanced surgery and novel techniques.”

Here is how to contact Hypospadias and Pediatric Urology Clinic at Ibn al Nafees Hospital, Manama, Bahrain:

Address:

Ibn al Nafees Hospital,

Rd No 3302, Manama, Bahrain

Appointments:

Dr Mahmood Abbas

Ibn Al Nafees Hospital

Phone: +973-17828246, 28247, 23209

By Whatsapp: +973-39467333

Email:

Hypospadias.bahrain@gmail.com

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

October 10 2012

Should a distal hypospadias be repaired!!

I did not know what was in store for me – there was 6 new patients in clinic and only 4 follow-ups and by the nature of it new patients take more time and follow-ups finish very fast. Anyway, the first patient who walked in was a 3 year old accompanied by young smart looking parents. The boy flashed a big smile and I said hello and he was eager to shake hands. That was a positive sign – Acceptance of me as a friend. Good so far.It was a nice Saturday evening, the watch clicked 7pm and I was in my Pediatric Urology clinic at Vashi with the last 10 urology appointments and was slated to be back home by 8pm.

Invariably on Saturdays I get late but today I was all energized to finish consultations fast and head back home for a quiet dinner and then catch up on much neglected sleep.

Then we got down to the business of consultation- the parents had looked up about hypospadias on internet and had found me and then travelled all the way to Navi Mumbai on a Saturday evening for a consultation for their little one who had hypospadias. I examined the eager and cooperative kid- he has a coronal hypospadias with mild tilt of glans (the head of penis). There was no chordee (actual bend of the body of penis) and testes were in normal location. Overall, it looked like a milder distal hypospadias which should be fairly easy to repair with a predictably good result.

I explained everything about hypospadias – how it happens and how it is repaired and then the QA began. The parents asked – “Is it necessary to repair it? We have heard that it can lead to long term urinary problems and sexual dysfunctions as sometimes the nerves get cut during sensation leading to a numb penis. Also, there are blogs which talk about no need to do surgery in distal hypospadias as there may be long term complications like hair growth, tight passage, fistulas etc.” They had visited an eminent Urologist who had advised against surgery.

Well, they had done their due research and it was good but sometimes the truth out there may not be whole truth. I had to counsel them and make sure that they know the whole truth while at the same time sounding detached from the whole process. It was after all their kid and their responsibility- my job was to give full, fair and medically sound information and then their job was to make the right decision for their kid.

So here are the facts as I discussed with them:

As the boy grows and finally the penis size become adult like, the deformity becomes more and more obvious. The glans (penis head) which was tilted will look more and more abnormal.
The prepuce will only be on the top of the head and not on the underside leading to an incomplete prepuce. It looks rather like the head of a cobra in adulthood
The urinary opening will be on the underside of penis and the urine stream will always be downward instead of forward as in a normal child.
The problems as stated above will be more cosmetic than functional but they affect the psyche as he will be able to see that the shape and configuration of his penis is quite different from that of other children. This can lead to deep seated emotional and social withdrawal issues in teenage and adulthood.
Repairs are easier with predictable and better results in childhood. Later on in teenage and adulthood repairs have higher failure rates and pain. Further erections can cause pain and instability in the repaired area after surgery.
The blogs out there contain stories of people who underwent surgery for hypospadias in childhood and now are adults. Thus the care which they received was 20-25 years back. The art & science of Hypospadiology has moved at much faster pace in last two decades and now- the understanding of anatomy of penis & hypospadias is much better, the surgical techniques have evolved and most of the repairs are done in single stage, new instruments for finer surgeries are available, new fine absorbable & non-reactive stitches are available and above all there are doctors who are well trained in managing the children with hypospadias.
Earlier surgeries using skin from scrotum or other body tissues are not done any more so currently any repair causing hair growth in urethra is outdated and not done by surgeons.
Complications like fistula, tight passage (stricture) are less than 5% in experienced, trained surgeons hands for milder distal hypospadias.

To sum up, it is worthwhile to repair distal hypospadias considering all the above. The science of hypospadias surgery has made sure that the children get the best results for surgery in their early childhood and then live their lives normal without worrying about their reproductive organs.

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Category Archives: Hypospadias Surgery

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation