adult hypospadias surgery Archives - Hypospadias Foundation

January 01 2024

Does Hypospadias cause male infertility?

For some men with hypospadias, a congenital condition where the urethral opening lies somewhere on the underside of the penis, questions about fertility can loom large. While hypospadias itself doesn’t directly impact sperm production, its associated complications can sometimes pose challenges. Hypospadias cause male infertility in certain cases due to these complications. But remember, this doesn’t mean that all men with hypospadias will necessarily be infertile. Let’s delve into the link between hypospadias and fertility, exploring potential concerns, available solutions, and fostering hope for fatherhood.

Understanding Hypospadias:

During fetal development, normally the urethra forms by folding of tissues from scrotum to the base of the penis to the tip of the penis. The failure of this urethral closure leads to hypospadias. The severity of hypospadias varies, with the opening appearing anywhere from the scrotum (scrotal hypospadias) to the base of the penis (penoscrotal hypospadias) to near the tip of the penis (distal hypospadias). Besides the misplaced opening, most men with hypospadias also have a downward bending of the penis during erection – called chordee. Hypospadias can cause male infertility as 5% of cases may also have an associated undescended or absent testis, which can lead to lower sperm production. Such men need to be investigated for a disorder of sex development (DSD) or intersex.

Hypospadias and Fertility: the Possible Connections:

In isolated hypospadias with both normal testes, the sperm production usually remains unaffected, yet certain hypospadias-related factors can influence fertility:
 Urethral location: In severe unrepaired hypospadias cases such as scrotal or perineal or penoscrotal hypospadias, ejaculation might not be able to reach the vaginal introitus, hindering fertilization.
 Penile curvature: Significant curvature can make intercourse physically difficult. Sometimes erection can also be painful when there is significant chordee
 Meatal stenosis: abnormal hypospadias opening may be very small leading to urinary and sperm flow obstruction.
 Prostatic utricular diverticulum: Some men with severe hypospadias may also have a large sac near their prostate gland where sperm tubes (vas deferens) open. In such cases sperms may not flow out easily for fertilisation.
 Post hypospadias surgery issues: At Hypospadias foundation, we see lot of men who have had repairs done earlier and have poor fertility though they have a normal sperm production. The common reasons for this are complications of hypospadias surgery such as: residual curvature or chordee, stricture in new passage, diverticulum or baggy new urethra or fistulae in the urethra.

 Psychological considerations: Emotional concerns about body image or sexual function can sometimes affect intimacy and overall fertility.

Hypospadias Treatment Options: Paving the Way for having children
Fortunately, advancements in hypospadias surgery and infertility treatment offer effective solutions for addressing hypospadias-related fertility concerns:
 Hypospadias repair surgery: This procedure reconstructs the urethra and corrects penile curvature, often restoring normal ejaculation and improving sexual function. If there are complications from previous hypospadias surgeries such as stricture, residual chordee, fistula or a diverticulum- these can be repaired by an expert hypospadias surgeon leading to cure for infertility.
 Assisted reproductive technologies (ART): In cases where natural conception proves challenging, sperm retrieval techniques like testicular biopsy or micro epididymal sperm aspiration (MESA) can be combined with IUI, IVF, or ICSI to achieve pregnancy.

Maintaining Hope: Fatherhood is Within Reach for people with Hypospadias:
Do consult an expert and best hypospadias surgeon first. The hypospadias surgeon will check and confirm that the hypospadias repair is proper and there is no structural issue in repair. If there is some residual issue in hypospadias surgery, then that needs to be corrected first. If the infertility persists, and you suspect hypospadias cause male infertility, then you must visit an andrologist for assisted reproductive techniques.

It’s crucial to remember:
 The majority of men with hypospadias have normal fertility.
 Early surgical intervention significantly improves the chances of successful fatherhood.
 Advanced treatments like ART offer alternative paths to parenthood. Open communication with your hypospadias doctor is key to understanding your unique
situation and exploring suitable fertility options. Remember, hypospadias does not define your potential as a father. With proper support and available treatments, you can navigate this journey and realize your dreams of having babies and building a family. At Hypospadias foundation, we treat hundreds of children and adults with hypospadias every year. Since 2008, Dr A.K.Singal, rated as the best pediatric urologist and hypospadias surgeon in India and the world, has devoted his life to helping people with hypospadias get best results and normal life. Along with Dr Ashwitha Shenoy, pediatric surgeon and hypospadias surgeon and a partner at Hypospadias foundation, the team at Hypospadias foundation, has deep expertise in diagnosing and treating complex hypospadias.
References:
 American Urological
Association: https://university.auanet.org/core/pediatric/hypospadias/index.cfm
 National Institutes of Health: https://www.ncbi.nlm.nih.gov/books/NBK482122/
 Mayo Clinic: https://www.mayoclinic.org/diseases-
conditions/hypospadias/diagnosis-treatment/drc-20355153

If you wish to have a teleconsult or a second opinion from Dr Singal/ Dr Shenoy, please write to us hypospadiasfoundationindia@gmail.com or fill up this contact form: https://www.hypospadiasfoundation.com/contact/

February 02 2019

Single stage buccal mucosa graft urethroplasty for an adult with failed hypospadias

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias is a common congenital birth defect which occurs in 1/150 boys in India. 20-30 years back the treatment for hypospadias was very not very successful as the procedure and surgical techniques very not very refined, the number of expert hypospadias surgeons focussed on treatment was less, sutures and instruments for hypospadias surgery were also very basic. With advancing knowledge and expertise, these days in 2019, the results of hypospadias repair (urethroplasty) are much better. A lot of adults in this century, underwent surgery as children way back in 1980’s and 1990’s and some of them did not get good results even after multiple hypospadias surgeries due to complications. Some of these people lost hope at a cure and did not pursue further surgery for failed hypospadias. At Hypospadias Foundation, we regularly get such young adults who come from all over India to seek best treatment and cure for Hypospadias. One of the new techniques to cure such adults with hypospadias is to use skin from inside the mouth for making new urethra- called oral or buccal mucosa graft urethroplasty. In hands of an expert surgeon, it has extremely good results.

Case History:

Mr A.G. 26 years old young man, engineer by profession, extremely smart and suave in nature, came to our hypospadias clinic one evening. He sat down and talked about the trauma of two failed hypospadias surgery which he underwent in Indore with a plastic surgeon. The last surgery was about 10 years back. He had lost hope for cure till he stumbled upon Hypospadias Foundation while searching online. He had come with a hope to get a cure for his hypospadias issue and get married soon. His present problem was thin stream of urine, pain while passing and leak of urine from underside of penis. On examination, his penis was straight (no chordee), he had a fistula in proximal penile region with thin unhealthy urethra. We sat with him and explained the plan to do a cystoscopy and check for quality of urethra and find out reason for repeated failure of surgery and then decide whether a one stage or two stage surgery is needed for full cure and best results of hypospadias surgery. A.G. agreed for the plan and wanted the best treatment.

Surgery:

On cystoscopy, we saw that his new urethra was thin and unhealthy. We cut it open from tip of penis to the site of fistula and actually little below that. We saw that the dorsal wall (roof of urethra) was healthy with minor scarring. We made a deep cut in the dorsal wall in the central midline. We took a buccal graft (oral or labial graft) from upper lip. The graft was fixed with absorbable sutures in the midline to form a part of the neo-urethra. The graft and surrounding urethral wall were rolled into a tube with absorbable sutures around a 14 Fr silicon catheter – all in one stage. The unhealthy skin was excised, and closure of skin also done in a cosmetic way. The catheter was removed after 3 weeks and at one month after catheter removal AG was passing urine in a thick stream without pain from the tip of penis. He was very happy and planning to get married soon. We advised him to marry atleast 6 months after hypospadias surgery. The new urethra is still a bit fragile for 3-4 months after surgery and it is better to wait for 6 months for intercourse (coitus/ sex) after surgery.

Buccal (oral) mucosa graft urethroplasty in adults:

An adult with multiple failed hypospadias surgeries, generally has no normal penile skin or prepuce left for hypospadias repair using local tissues from penis. Hence in such patients, it may be better to use skin from inside the mouth for making the new passage. The skin can be easily taken from inside of cheek or lips. The defect heals very fast and generally without much complications. The buccal graft adapts to penile location very well and has great long-term results in failed surgery. While some of these cases are suitable for a single stage surgery, some may require two stage surgery depending on the severity of the defect. Nonetheless, Buccal Graft Urethroplasty remains a great option with best long-term results for children and adults with Failed Hypospadias.

At Hypospadias Foundation in India, Dr Singal and his team have one of the best hypospadias surgery results in the world. Children and adults from more than 20 countries such as UAE, Bahrain, Iran, Iraq, Afghanistan, Saudi Arabia, Pakistan, Bangladesh, Malaysia, Tanzania, Nigeria, Congo, Ethiopia, Kenya, Nepal, Indonesia, Egypt, Jordan etc come for treatment at our foundation. It is indeed heartening to see them go back with final cure from hypospadias.

To contact us write an email to hypospadiasfoundationindia@gmail.com or contact us at +91-9821261448 between 9am-6pm India time or fill up this form for enquiry.

Watch Buccal Mucosa Graft Urethroplasty Video here:

Watch Two staged Buccal Mucosa repair surgery in a child:

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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