expert hypospadias surgeon Archives - Hypospadias Foundation

February 02 2026

Is there an age limit for hypospadias repair surgery?

Hypospadias is a congenital condition in which the urinary opening (meatus) is located on the underside of the penis instead of at the tip. Hypospadias repair surgery is a well-established and successful procedure that can be performed in infants, children, adolescents, and adults. However, choosing the best age for hypospadias repair plays an important role in healing, recovery, and long-term outcomes.

What Is the Best Age for Hypospadias Surgery?

Most expert hypospadias surgeons recommend performing surgery between 6 and 18 months of age. Surgery before 3 years of age is considered ideal, and if someone misses this period, surgery before 8 years of age is still strongly recommended if early repair was not possible.

Hypospadias Surgery in Infants (6–18 Months)

The ideal age for hypospadias surgery is between 6 and 18 months. At this age:

Penile tissues are soft, elastic, and heal faster
Scarring is minimal due to high tissue regeneration
Infants are unaware of their genitalia and body image
There is no psychological impact or memory of surgery

Early hypospadias repair also allows normal toilet training and smooth bladder control development. Post-operative care is easier in infants, as diaper changes simplify wound care and recovery is less stressful for parents.

Hypospadias Surgery Before 3 Years of Age

If surgery cannot be done in infancy, completing hypospadias repair before 3 years of age still provides excellent results. Children recover well, healing is fast, and long-term functional and cosmetic outcomes remain very good.

Hypospadias Surgery in Older Children

Hypospadias surgery in older children is safe and effective, though recovery can be more challenging.

Older children:

Are more aware of their genitalia and may feel shy or anxious
Experience more fear and perceived pain after surgery
May find dressing changes difficult
Sometimes hold urine after catheter removal due to fear of pain

Despite these challenges, healing and success rates remain high when surgery is performed by an experienced hypospadias surgeon.

Hypospadias Surgery in Teenagers

Teenage boys with untreated or failed hypospadias often feel embarrassed and reluctant to undergo surgery. In cases of hypospadias with chordee (penile curvature), we recommend delaying surgery until penile growth is complete. Avoiding surgery during active growth may prevent interference with natural penile development

Hypospadias Surgery in Adults

Hypospadias repair in adults is possible and can be highly successful. However, recovery is slower compared to children because:

Adult penile skin is thicker and less elastic
Healing takes longer
Pubic hair can affect wound care
Night-time erections may stress sutures and increase complication risk
Infection issues are higher
Urethral and extra safety supra-pubic catheter are also needed.

Even in adulthood, good outcomes are achievable in expert hands. Adult hypospadias surgery success rates at Hypospadias Foundation India are over 95%, which are best in the world.

Is There an Age Limit for Hypospadias Surgery?

There is no upper age limit for hypospadias surgery. The success of repair depends more on the experience of the hypospadias surgeon than the age of the patient. With proper evaluation and surgical expertise, excellent results can be achieved even in adulthood.

Importance of Choosing an Expert Hypospadias Surgeon

Before planning hypospadias surgery, it is essential to consult a specialist hypospadias surgeon. An experienced surgeon will:

Carefully examine the child or adult
Assess severity, chordee, and previous surgeries
Recommend the best timing and surgical technique

At Hypospadias Foundation, children and adults from over 30 countries undergo hypospadias repair. The oldest successfully treated patient was a 50-year-old man with failed hypospadias repair and urethral stricture, operated without complications. This highlights the importance of choosing a specialized center for hypospadias treatment.

Dr A K Singal is a highly experienced and internationally renowned hypospadias surgeon in India, widely regarded as one of the leading experts in hypospadias repair for both children and adults. He has dedicated his professional life to the treatment of complex and failed hypospadias cases, helping patients achieve excellent functional and cosmetic outcomes.

With decades of focused experience in primary and redo hypospadias surgery, Dr Singal’s expertise has contributed to consistently high success rates in infants, older children, adolescents, and adults with hypospadias.

Dr Ashwitha Shenoy is an expert pediatric surgeon with a special interest in pediatric urology and hypospadias surgery. Her training and experience in managing hypospadias in children ensure meticulous surgical care, age-appropriate planning, and excellent long-term outcomes.

Together, Dr A K Singal and Dr Ashwitha Shenoy work as a dedicated team to provide comprehensive hypospadias treatment in India. Their combined expertise allows them to manage simple to complex hypospadias cases, including failed repairs and adult hypospadias, delivering some of the best outcomes for hypospadias surgery in India.

Contact us:

For appointment kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India – Tue/Saturday 4:00pm-6:00pm, Call for appointments: +91-6262840940. Or email us at hypospadiasfoundationindia@gmail.com

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February 02 2026

Single stage hypospadias repair in distal penile hypospadias with chordee

Mast A.T., a one-year-old male, presented to the Hypospadias Foundation clinic with an abnormal ventral urinary opening on underside of penis and downward penile curvature. Clinical examination revealed a distal penile hypospadias, deficient ventral foreskin, and
ventral chordee (penile curvature).

A single-stage surgical hypospadias repair was planned, comprising of chordee correction (Orthoplasty) and urethroplasty (reconstruction of the urinary channel)

Intraoperative Procedure

The procedure commenced with a 5-0 Prolene stay suture on the glans for traction. Local anaesthesia (Xylocaine with adrenaline) was infiltrated at the marked incision sites. Following the initial incision and complete degloving of the penis, an artificial erection test was performed to assess the degree of curvature.

 Chordee Correction: A curvature of less than 30 degree was noted. This was corrected via Tunica Albuginea Plication (TAP) on the dorsal aspect (upper part) of the penis, opposite the site of maximum curvature. A repeat artificial erection test confirmed complete correction of the chordee.

 Urethroplasty: The glans wings were marked, incised, and widely mobilized. A midline incision was made in the urethral plate to increase its width (TIP – Tubularized Incised Plate technique). The neo-urethra was constructed in two layers:

o Layer 1: Continuous subcuticular sutures.
o Layer 2: Interrupted sutures.

 Waterproofing: A preputial dartos flap was raised and transposed over the urethroplasty site to provide a vascularized waterproofing layer, significantly reducing the risk of a fistula (leak).

 Completion: Glansplasty was performed to reconstruct the glans. The skin was closed in two layers using 6-0 PDS and 6-0 vicryl Rapide.

Postoperative Outcome and Follow-up

The repair was stented using a 7 Fr infant feeding tube, with the new meatus successfully positioned at the tip of the glans.

 Day 7: The catheter and dressings were removed. The patient demonstrated a strong, straight urinary stream with no associated pain.

 Healing: The surgical site healed by primary intention without complications (e.g., hematoma, infection, or dehiscence).

 1-Year Follow-up: The patient remains asymptomatic with excellent functional and cosmetic results.

Pic 1: Clinical examination shows presence of chordee with meatus in the distal penile region

Pic 2: Complete degloving done

Fig 3: Artificial erection test shows less than 30-degree chordee which was corrected by 12’o clock dorsal tunica albuginea plication (dorsal TAP)

Fig 4: Glans wings raised and urethroplasty done over 7Fr infant feeding tube. Right dartos flap raised and sutured over the urethroplasty with 6-0 PDS.

Fig 5: Single stage urethroplasty with chordee correction completed

Fig 6: At 7 days follow up after surgery

Fig 7: At 1 year follow up after surgery, passing urine in single straight stream

Single-stage hypospadias repair in distal penile hypospadias with chordee Single-stage hypospadias repair is the preferred surgery for distal penile hypospadias associated with mild chordee. Though the urinary opening is positioned near the glans, the reconstruction has to be done with utmost care by the hypospadias expert.Even a little bit of carelessness can lead to complications.

 Primary Technique: The Tubularized Incised Plate (TIP) urethroplasty—commonly referred to as the Snodgrass repair—is the most widely utilized method. This procedure involves a midline incision of the urethral plate to allow for tension-free tubularization, ensuring a functional and cosmetically normal neo-urethra.

 Optimal Age for Surgery: Pediatric urologists generally recommend performing this repair between 6 and 18 months of age. This "golden window" facilitates rapid tissue healing, simplifies postoperative diaper management, and minimizes the risk of long- term psychological impact on the child.

Outcomes and Success Rates

When performed by an expert hypospadias surgeon in a specialized center like Hypospadias Foundation India, the success rate for distal repairs exceeds 95%. However, clinical diligence is required to monitor for potential postoperative hypospadias complications.

Functional Rationale for Early Surgical Intervention

While distal hypospadias may appear manageable in infancy, untreated cases often lead to significant functional and psychosocial challenges as the patient matures:

1. Backward flow of urine: If the urinary opening is located on the underside of the penis, the stream is directed backwards causing inconvenience to the boys. Boys will have difficulty in using a urinal and they cannot urinate without getting urine on their clothes or shoes.

2. Sexual Health: Persistent chordee (ventral curvature) can lead to painful erections or Mechanical difficulties with intercourse in adulthood.

3. Psychosocial Impact: A non-apical urinary opening can cause significant social anxiety and hygiene concerns regarding standing to void.

Clinical Summary: Early repair of distal hypospadias with chordee is not merely cosmetic; it is a functional necessity that ensures optimal urogenital health and quality of life into adulthood.

The Hypospadias Foundation: A Global Center of Excellence

Located in Kharghar, Navi Mumbai, Maharashtra, the Hypospadias Foundation stands as India’s premier and best hypospadias specialty center and a globally recognized leader in hypospadias treatment.

Why Patients Choose Our Center:
For over 18 years, we have been a destination for both pediatric and adult patients from across India and the world. Our commitment to surgical precision and patient care is reflected in our clinical data:

 High Volume: Over 250 specialized surgeries performed annually.

 Proven Safety: A complication rate of less than 5%, significantly lower than the global average for complex reconstructions.

 Global Reach: Successfully treating international patients from more than 30 countries with diverse anatomical challenges.

Our Expert Surgical Team

The foundation’s success is built on the combined expertise of two of the world’s leading specialists in reconstructive urology.

Dr A. K. Singal is a top-tier expert hypospadias surgeon and pediatric urologist who has dedicated his career to the advancement of hypospadias repair. His refined techniques have consistently achieved excellent functional and aesthetic outcomes for both children and adults, particularly in complex "redo" or failed previous surgeries. He is rated the best hypospadias surgeon in India and the world.

Dr Ashwitha Shenoy is an expert pediatric urologist with a sub-specialty interest in pediatric urology and hypospadias. Her meticulous approach to neonatal and childhood reconstruction ensures long-term success from a young age. Together, Dr. Singal and Dr. Shenoy provide a collaborative, multidisciplinary approach that delivers the best results for hypospadias surgery in India.

December 12 2025

Failed Hypospadias with distal penile fistula – Single stage redo urethroplasty

Mast B.E, 14-year male from Mumbai had undergone two unsuccessful hypospadias repairs at another hospital in the past. He presented to Hypospadias Foundation with complaints of passing urine from two sites, which is from the tip and from the distal penile region. On clinical examination, there was an eccentric subcoronal fistula with a thin glans bridge separating it from the glanular meatus. There was some residual skin on the dorsal side. The urine stream was spraying as shown in the photo below

Picture 1: On clinical examination, there was an eccentric distal penile fistula with thin glans bridge separating it from the glanular meatus

Picture 2: Urine stream was poor with spraying of urine.

He was planned for single/ two stage repair depending on the degree of chordee, status of native urethra and quality of urethral plate. Cystoscopy was noted to be normal. Chordee assessment showed no residual chordee. The thin glans bridge between the meatus and the fistula was divided. The urethral plate was noted to be wide with no scarring. Considering all the above factors he was planned for single stage repair – simple tube urethroplasty or Glans Approximation Procedure was decided.

Picture 2: Artificial erection test showed no residual chordee. Urethral plate was noted to be wide and healthy.

Stay suture was taken on the glans with 4-0 prolene. Complete degloving was done. Artificial erection test showed no residual chordee. Glans wings were marked and raised. Urethroplasty was done by continuous inverting subcuticular sutures with 6-0 PDS over 8Fr infant feeding tube. Second layer closed over the urethroplasty with local tissues with 6-0 PDS interrupted sutures. Right dartos flap was raised and sutured over the urethroplasty with 6-0 PDS. Glansplasty was done with 5-0 vicryl. Unhealthy skin was excised; edges were freshened and closed in 2 layers with 6 0 PDS and 6-0 vicryl rapide.

Picture 3: Complete degloving done and chordee assessed by artificial erection test. No chordee noted.

Picture 4: Urethroplasty done with 6-0 PDS, followed by glansplasty and skin closure

Picture 5: Appearance and urine stream at 2 weeks after catheter removal

Picture 6: Follow up at 6 months after surgery

Click here to watch the entire video of this surgery
Redo urethroplasty for a distal urethral fistula – Hypospadias Foundation, India

Redo urethroplasty for failed hypospadias

Redo urethroplasty for failed hypospadias is a highly complex and challenging surgical procedure. The primary goal is to address the complications of the initial surgery which are often associated with tissue scarring, shortage of tissues and presence of residual chordee. The general goals for any redo urethroplasty are to straighten the penis (correct any residual chordee), to reconstruct the urethra (create
a new wide and patent urinary passage) and place the urinary opening at the tip of the penis (glanular meatus).

Redo hypospadias repair should be performed by a experienced pediatric urologist or hypospadias surgeon who has expertise in complex hypospadias repairs. Surgeon should wait atleast 6 months after the initial repair to allow the inflammation to subside and for the scar tissue to soften. Sometimes if there is significant scarring, we wait for even 1-2 years and use steroid creams to soften the scar area.

About Hypospadias Foundation

Hypospadias Foundation is a centre specialized for treatment of children with hypospadias. It is located at MITR hospital, Kharghar, Navi Mumbai in the state of Maharashtra, India. Our expertise in primary and redo hypospadias repair makes us one of the best centres for hypospadias treatment in the world. We get children from more than 30 countries in the world with various types of complications after hypospadias surgery done at other centres and we are able to repair them successfully with good cosmetic outcomes. This is possible because of our dedication in the field of hypospadias.

Dr A K Singal is an expert and top hypospadias surgeon in India. He is a gifted surgeon and his expertise in this area has helped us achieve excellent outcomes in primary and failed hypospadias in children as well as adults.

Dr Ashwitha Shenoy is an expert hypospadias surgeon with special interest in hypospadias and pediatric urology. Both Dr Singal and Dr Shenoy work together to give best results for hypospadias surgery in India for both children and adults.

Single stage hypospadias repair in a child with recurrent distal penile fistula

A urethral fistula after hypospadias repair is an abnormal communication that forms between the newly reconstructed urethra and the skin on the underside of the penis. This is the most common complication that occurs after hypospadias surgery. In this condition, the urine comes from the tip of the penis and leaks from the fistula site.

This fistula mostly occurs due to issues with healing of the urethra. The common reasons include tension on the newly reconstructed urethra, poor blood supply at the operated site, gaps during closure, infection at the operated site, narrowing or stricture formation in the new urethra or straining while passing stool in the post operative period.

Children who form fistula after hypospadias surgery come with leaking or dribbling of urine from the fistula site. Symptoms usually appear within a few weeks to months after the initial hypospadias repair.

The primary treatment is surgical repair if they do not close on their own. It is standard practice to wait for atleast 6 months after the initial hypospadias repair before attempting fistula closure. This allows the tissues at the urethral fistula site to soften, improve blood supply and increase the success rate of second surgery. The fistula tract is identified and excised to create healthy tissue edges for repair.

The urethral fistula site is closed in multiple layers as done in the above-mentioned case to ensure a watertight seal and prevent recurrence. Before closing the fistula, it is always necessary to confirm that the urethra beyond the fistula site is not narrow or tight. In the presence of distal obstruction, the urethral fistula closure surgery may fail.

If your child has developed urethral fistula after hypospadias repair, then it’s necessary that you see a hypospadias specialist who will assess what is best for your child and choose the best technique minimizing the risk of complications and improving the chances of success.

About Hypospadias Foundation

Hypospadias Foundation is a centre specialized for treatment of children with hypospadias. Hypospadias foundation is located at MITR Hospital in Kharghar, Navi Mumbai in the state of Maharashtra. Our expertise in hypospadias makes us one of the best centres for hypospadias repair in the world. We treat children from more than 25 countries in the world and from all over India. Our dedication in this field has helped us achieve excellent outcomes.

December 12 2024

Navigating Uncertainty: Understanding the Risk of Hypospadias in a Second Child

The birth of a child brings immense joy, but also concerns about their health and well-being. For parents who have experienced the challenges of hypospadias in their firstborn, questions about the risk of recurrence in a second child understandably arise. This blog aims to provide insights and guidance on this sensitive topic.

What is Hypospadias and is it necessary to repair it?

Hypospadias is a birth defect affecting boys, characterized by an abnormally positioned urethral opening. This opening, which normally lies at the tip of the penis, can be located anywhere along the shaft, scrotum, or even perineum. While the severity varies, hypospadias can affect urination, sexual function, and self-esteem. For very minor hypospadias without any chordee, family may choose to not do surgery but after consultation with an expert hypospadias surgeon. For all other hypospadias, correction surgery is recommended.

Is My Second Child at Risk of Hypospadias?

The possibility of hypospadias occurring in a second child depends on several factors:

Family history: If the father or a brother has hypospadias, the risk in subsequent sons increases. Estimates suggest 5-6% risk for a second son and this risk increases further if both father and brother are affected.
Environmental factors: Exposure to certain environmental toxins, such as pesticides and herbicides, may play a role. These pesticides are known to be endocrine disruptors, they interfere with the androgen and oestrogen signalling pathways during genital development, hence causing hypospadias. This is a hypothesis, and studies are still under process to clearly link exposure of pesticides to occurrence of hypospadias. There have been studies showing higher risk of hypospadias due to plasticisers in the single use plastic bottles. The chemicals here act as male hormone blockers and interrupt development of penis, hence causing hypospadias.
Hormonal exposure in pregnancy: During pregnancy, certain hormones may be advised for the mother to decrease the chance of preterm labour or miscarriage. This is common after invitro fertilization (IVF) conception, twin pregnancy and in precious pregnancies. Carmichael in his study reported that the use of progesterone to prevent early pregnancy loss was associated with risk of developing moderate to severe hypospadias¹.
Maternal health: Maternal smoking, pre pregnancy obesity, folic acid deficiency is some of the associated factors causing hypospadias.

Understanding the Probabilities of second child with hypospadias

While the above factors influence the risk, it’s important to understand that they do not guarantee the condition’s recurrence. Each pregnancy is unique, and predicting with certainty is impossible.

Here’s a breakdown of the estimated risks:

For a family with no history of hypospadias, the general risk is around 1 in 250 births
If the father has hypospadias, the risk rises to about 1 in 50
With a brother affected, the risk increases to approximately 1 in 30
When both father and brother are affected, the risk becomes roughly 1 in 20

Moving Forward: Taking Charge

Despite the uncertainty, proactive measures can empower parents to understand hypospadias and get proper counselling to understand the possibility of hypospadias in their second child. This includes:

Genetic counselling: Consulting a genetic counsellor can provide personalized risk assessment and guidance based on your specific family history. Genetic analysis can help us know the possibility of hypospadias in subsequent pregnancies.
Preconception care: Maintaining good health and avoiding harmful substances during pregnancy can minimize potential environmental influences. Folic acid supplementation should be started before conception and continued during the first trimester to avoid hypospadias.
Prenatal testing: While currently no specific tests diagnose hypospadias in utero, advanced ultrasound technology may detect anatomical abnormalities suggestive of the condition. This is possible only in countries where predetermination of sex of the child is allowed in ultrasound in pregnancy.
Early diagnosis and intervention: If hypospadias is diagnosed after birth, early intervention through specialized treatment can optimize outcomes. Early referral to an expert hypospadias surgeon, early surgery can help the parents and child to overcome the hypospadias problem.

Remember that Knowledge is power. By understanding the risk factors and available resources, parents can navigate the uncertainty surrounding hypospadias and make informed decisions about their second pregnancy.

Let’s work together to raise awareness and offer support to families affected by hypospadias.

Additional Resources:

Carmichael SL, Shaw GM, Laurent C, Croughan MS, Olney RS, Lammer EJ. Maternal Progestin Intake and Risk of Hypospadias. Arch Pediatr Adolesc Med.2005;159(10):957–962. doi:10.1001/archpedi.159.10.957
Urology Care Foundation: https://www.urologyhealth.org/educational-resources/hypospadias
National Institute of Child Health & Human Development: https://pubmed.ncbi.nlm.nih.gov/35398463/
Hypospadias Association: https://heainfo.org/

About Hypospadias Foundation

Hypospadias Foundation is a centre specialized for treatment of children with hypospadias. Our expertise in hypospadias makes us one of the best centres for hypospadias repair in the world. We treat children from more than 25 countries in the world and from all over India. Our dedication in this field has helped us achieve excellent outcomes. Hypospadias foundation is located at MITR Hospital in Kharghar, Navi Mumbai in the state of Maharashtra.

Contact Form for Hypospadias Foundation

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Tag Archives: expert hypospadias surgeon

What Is the Best Age for Hypospadias Surgery?

Hypospadias Surgery in Infants (6–18 Months)

Hypospadias Surgery Before 3 Years of Age

Hypospadias Surgery in Older Children

Hypospadias Surgery in Teenagers

Hypospadias Surgery in Adults

Is There an Age Limit for Hypospadias Surgery?

Importance of Choosing an Expert Hypospadias Surgeon

Contact Form for Hypospadias Foundation

What is Hypospadias and is it necessary to repair it?

Is My Second Child at Risk of Hypospadias?

Understanding the Probabilities of second child with hypospadias

Moving Forward: Taking Charge

Additional Resources:

About Hypospadias Foundation

Contact Form for Hypospadias Foundation