hypospadias repair surgery Archives - Hypospadias Foundation

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

November 11 2014

Good results of hypospadias repair surgery in adults even after previous failed repairs

Besides 100,000 kids born in India every year with hypospadias, there are an estimated 5-10 lakh adults living with either unoperated hypospadias or failed hypospadias having complications of Hypospadias surgery. These can be minor issues such as urethral fistula, chordee or suboptimal cosmetic results but a significant number may have major issues such as completely failed hypospadias, urethral diverticulum, hairy urethra, urethra stricture etc. Unable to come to terms with penile deformity, they do not get any hope or assurances from adult urologists or plastic surgeons as this may not be the area of primary interest or dedication for them.

Mr Rajveer Singh, 30 years old man, had a midpenile hypospadias with chordee and was operated by a plastic surgeon in Hissar Haryana 2 years back. After surgery, there was a breakdown of hypospadias repair and he was still passing urine from underside of penis. He was still having a downward curvature of penis (chordee) even after this surgery. Also he had seen hair growing out of urinary opening over last few months. He was very worried as he wanted to get married, hence he wrote to us asking for help. We wrote back asking for detailed pictures on email which would help us in understanding his clinical condition and hypospadias deformity. Finally, we called him to see us at Hypospadias Foundation in Kharghar, Navi Mumbai. He took a flight from Delhi to Mumbai and landed up in my Hypospadias clinic on a Monday evening. On examination, he had a urinary opening much below the head of penis in midpenile region and also a couple of holes (urethral fistula) from where he was leaking urine. More importantly his penis still looked bent due to uncorrected chordee. Lastly the cosmetic outcome was really bad with tags of skin here and there and we could see hair coming out of his urethra due to previous failed improper hypospadias surgery. This results when an undertrained hypospadias surgeon uses hairy penile skin for urethral reconstruction. We counselled Rajveer regarding the surgical plan the first step of which would be excision of all unhealthy skin tissue on underside of penis, chordee correction (straightening of penis) and then decide for the type of hypospadias repair in operation theatre. This would be either a single stage repair using a local flap from hairless penile skin or a staged repair using a buccal mucosa graft. In staged buccal mucosa graft – we first excise all unhealthy tissue and scars of failed hypospadias repair, then take a thin lining from inside of lower lip or cheek and then place it as a graft on underside of penis. Once this graft gains local blood supply from penis tissue, we roll it into a urethral tube typically after 6 months of first stage. We always keep buccal graft as the last option in failed hypospadias as that essentially means multiple surgeries. Hence, we attempt to do a single stage flap repair whenever feasible even in failed hypospadias and hence we shared this intent with Rajveer.

Rajveer was taken up for surgery the next day under spinal anesthesia and first a cystoscopy was done. It showed normal urethra beyond midpenile region and unhealthy scarred hairy urethra with fistulae in the distal penile region. We excised all the unhealthy tissues and then checked for chordee. There was still 30 degrees bend in penis which needed correction by a 12 O’clock non-absorbable stitch on the top side of penis. On rechecking with artificial erection, there was no chordee now. After chordee repair was satisfactory, we analysed the penile skin on the right side of penis. We could see an island of hairless skin which was possibly remnant of foreskin (prepuce). We designed a long flap from this with very good blood supply from the underlying dartos tissue. This flap was used in an onlay fashion to repair hypospadias in a single stage. Finally head of the penis (glans) was also repaired and a catheter was placed to drain urine till the whole repair healed. Rajveer went back to his home town in Haryana after 3 days of surgery and then we arranged for one of my surgeon colleagues in Hissar (Dr Vivek Gupta) to help with post hypospadias surgery care. The catheter was removed on day 14 since it was a major hypospadias reconstruction. Rajveer passed urine well and but the full healing of the penis took about 4 weeks. The final cosmetic result was excellent when he sent the pictures via email. He visited us recently almost 3 months after surgery, the penis looked well healed and he is passing urine well from the tip in a good stream. His erections are straight and he is now looking forward to get married. The only question is whether he will invite me for his wedding or not and if he invites, how will he introduce me.

When such complex failed cases do well after hypospadias treatment at Hypospadias foundation, it makes us very happy. We feel our goal of starting the foundation in Nov 2008 has been fulfilled. Last six years have been a long and exciting journey but is has been a very challenging time. When we started we never knew the burden of problem was so high. Along the way we have been privileged to be a part of lives of more than 600 kids and adults with Hypospadias from all over India and some countries abroad. Almost 25% of those receiving treatment at Hypospadias Foundation, have been patients with failed hypospadias who received surgery elsewhere. Though initially we started only with management of hypospadias in children but we realized that there is huge gap when it comes to treatment of hypospadias in adults. Along with Dr Manish Dubey, my close friend who is an adult urologist we are able to offer good care and success rates in adults and failed hypospadias.

In last three years, Hypospadias Foundation has welcomed many patients from many other states and countries such as Nepal, Bangladesh, Greece, Afghanistan, Iraq, Saudi Arabia, UAE-Dubai, Oman, Great Britain (UK), USA, Nigeria, Tanzania, Kenya, Congo, Zambia and this number continues to grow attesting to our devotion to the field of Hypospadias. Within India, kids and their families have travelled for treatment of hypospadias from Assam, Kolkata, Orissa (Puri, Bhubhaneshwar), Ranchi, Chattisgarh (Raipur, Katni), Gujarat (Ahmedabad, Surat, Baroda, Gandhinagar), MP (Indore, Bhopal), Himachal, Delhi, Haryana (Hissar, Rohtak, Panipat), Rajasthan (Bikaner, Jaipur, Jodhpur), Maharashtra (Jalgaon, Pune, Aurangabad, Nasik, Nagpur, Parbhani, Dhule, Solapur, Kolhapur, Ahmednagar, Ratnagiri), Uttar Pradesh (Lucknow, Allahabad, Meerut), Goa, Andhra Pradesh (Hyderabad, Belgaum, Guntur), Uttarakhans (Dehradun), Jammu, Kerala (Cochin), Tamilnadu (Chennai, Salem, Coimbatore) and Punjab (Chandigarh, Ludhiana and Patiala).

About the author:

Dr A.K.Singal is a Pediatric Urologist and Hypospadiologist practicing in western india in area of Navi Mumbai and Thane. He is counted as one of the best hypospadias expert surgeons in the world and every year manages more than 200 kids and adults with hypospadias. He is available at the following clinics :

Clinics and Appointments for Dr Singal

To send an enquiry to Dr Singal’s team please fill up this form: Contact Dr A.K.Singal

Watch video of Single stage repair surgery of severe hypospadias by Dr A.K.Singal

Watch video of repair of glanular hypospadias with chordee by Dr A.K.Singal

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

Contact Form for Hypospadias Foundation

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

June 06 2014

Excellent results of Hypospadias repair surgery – TIP urethroplasty (Snodgrass Repair) for distal penile hypospadias

Hypospadias is one of the most common malformations in boys and affects more than 1 lakh kids in India. At Hypospadias foundation and MITR Hospital, Kharghar, Navi Mumbai, India – we see and manage more than 200 kids every year who have hypospadias and need surgery. These cases are either primary (75%) or those have failed surgery elsewhere (25%)- some of them have failed multiple surgeries elsewhere.

We strongly believe that hypospadias surgical correction should not be taken lightly or casually by any surgeons as first hypospadias surgery is the best chance which the child has. Once the first hypospadias surgery has a complication, more surgeries are needed and still the result may not be optimal. Hence, the surgeon needs to be well trained for hypospadias repair procedure and should have a very keen and passionate interest before he takes up any child up for surgery for hypospadias.

Amongst the various techniques for hypospadias surgery, one of the most popular one is Tubularised Incised Plate (TIP) urethroplasty. TIP repair was first described by Prof Warren Snodgrass and it currently constitutes 70% of all distal and midpenile hypospadias repairs across the world. Due to its universal adoption and remarkable results, it is also known as Snodgrass repair. I had the good fortune of assisting Dr Warren Snodgrass during his multiple visits to India when I was a resident in pediatric surgery at All India Institute of Medical Sciences. I keep bumping him into now and then at pediatric urology conferences, the last one of which was European Society of Pediatric urology Congress in Genoa Italy. We received the best paper award at the conference and it was nice to see Dr Warren Snodgrass applauding us.

While TIP repair or Snodgrass urethroplasty has excellent results, case selection before surgery is very important. The criteria are:

Distal or midpenile hypospadias
Mild to moderate chordee which is correctable
Wide pink elastic urethral plate.

In certain selected proximal hypospadias, Snodgrass repair can be used but on a personal level- a long Snodgrass repair may not be the best option in most cases. We have started using Onlay Island flap repair in most of our proximal hypospadias and all distal/ mid penile hypospadias which are unsuitable for TIP Urethroplasty.

Steps of surgery:

Degloving the penis and chordee correction – straightening of the curvature of the penis
Midline urethral plate incision
Neo-urethra formation on a catheter
Second layer coverage with either a dartos flap or spongiosum
Penile skin cover with Byars flap which helps in creating a midline closure on underside of penis. After the healing is finished, penis looks like just a circumcised penis. In some selected cases Prepucial reconstruction can be offered.

You can watch the video of a Snodgrass Urethroplasty for a distal penile hypospadias here.

In my experience as an expert hypospadias surgeon, while doing TIP urethroplasty everything has to be done meticulously to prevent complications. If I have to narrow down on two things which have really lessened the complications of hypospadias repair with Snodgrass urethroplasty at our centre are:

Fashioning a wide caliber neo-meatus- so that there is no narrowing later on
Providing a second layer cover on new urethra with either spongiosum or a dartos flap.

Master Soham’s parents stay in Latur, Maharashtra and their son was diagnosed to have a distal penile hypospadias at birth. Worried about multiple surgeries and poor outcomes for hypospadias repair- They searched for the best hypospadias surgeon on the internet and landed up in our pediatric urology clinic at MITR Hospital in Kharghar, Navi Mumbai. We did the surgery using a Snodgrass repair technique in First week of May 2014. The surgery went well and child was discharged the evening of surgery. The dressing and catheter were removed 5 days after surgery and now one month after followup the child has an excellent outcome after hypospadias repair surgery. The cosmetic appearance is excellent with a meatus at the tip of penis, straight penis and just a circumcised appearance.

Good cosmetic outcome after single stage hypospadias repair surgery

Parents are also happy and overjoyed.

Happy parents – after successful hypospadias repair surgery

If you wish to consult Dr Singal you can fill up this contact form here:

http://hypospadiasfoundation.com/contact-patient.htm

Or call up Dr Rajkumar at +91-9821261448 to discuss anything

Contact Form for Hypospadias Foundation

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

June 06 2014

Checklist before Hypospadias Repair Surgery

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias is a birth defect which affects a vital organ of the body- Penis. Penis is the most important organ for urinary and sexual function in a male. Though everyone worries more about sexual function, let me tell you as an expert hypospadias surgeon and a pediatric urologist that both urinary and sexual functions are equally important. While we may need penis for sexual function may be once or twice a day and for maybe for 30-40 years in our lives, we certainly need it for urinary function right from birth till we die and many more times each day. Hence the purpose of hypospadias repair is to set both the functions right in one go- single stage urethroplasty. This includes correction of the curvature of the penis (chordee correction) as well as making a good caliber smooth new urethra till the tip of penis.

But all said and done – Hypospadias treatment means a surgery. Surgery word itself is very scary and it requires a lot of courage and faith for the parents to handover their little one to a surgeon and let me tell you it is not easy for parents to hand over their young kid for a surgery. Lot of things go around in their minds about risks, results and safety of both surgery and anesthesia. Having been a pediatric urologist for almost a decade now, I can feel their helplessness and pain. I never let these feelings overpower me and become a stumbling block to delivering good care. I try to channelize them in the right way and empathize with the family and tell them upfront that I know how they are feeling. And then I tell them what all safety precautions and risk mitigation strategies we have lined up for the hypospadias surgery. My favorite sentence at this juncture is “Safety first everything else later”.

An helmet/ bike analogy works well in this situation: we should always follow all precautions before we go for a bike ride and most importantly wearing a helmet. We may wear a helmet a thousand times and not have an accident but the day we don’t wear it that is the day when we are vulnerable and if something happens- it will be life threatening. Similarly, while doing a hypospadias surgery on a small kid we also take all precautions to make sure that we are absolutely prepared even if something happens in that rare 1/1000 chances.

Hypospadias Surgery Checklist:

Pre-operative fitness tests: A thorough history is taken for any evidence of infection, other illness and any familial disorders. A complete blood count and a urine test is done to check for body parameters. A pediatrician consult is often taken for a systemic examination. Chest xray is no longer recommended routinely before elective surgery if the chest examination is normal.
Pediatric Anesthesiologist: An anesthesia doctor adept at handling kids and regularly giving anesthesia to small kids is the second most important team member after the pediatric urologist.
Hypospadias surgery set: Hypospadias repair surgery require fine, sharp and specialized microsurgery instruments- we keep is separately as a “Hypospadias Set” which is not used for any other surgery.
Operation theatre: OT needs to be clean, sterilized, have all safety equipment for anesthesia, good lighting and all possible infection control measures.
Antibiotic dose just before surgery: We give a dose of injectable broad spectrum antibiotic just before starting the surgery as an infection prevention measure.
Trained staff: Well-trained nursing and junior doctor staff is needed both while assisting surgeries as well as post-operative management, since at Hypospadias foundation at MITR Hospital, Navi Mumbai, India- we do more than 150 hypospadias repairs every year- even the ward assistants know the care of these babies after surgery.
Standardised protocol of surgery: This has been covered in another blog- read it here.

As a Pediatric Urologist and Hypospadias Specialist, I feel overwhelmed when parents trust me and handover their little ones under my care. It is a big responsibility and I try my best to handle them with care. Trust and faith that everything will be fine goes a long way in finding a cure for hypospadias. After all we are all instruments of god trying to do our best. As long as the intentions and efforts are honest, the results will also be good.

About Dr A.K.Singal: Dr Singal is a renowned and top pediatric urologist & one of the best hypospadias surgeons in India. He is well known for single stage hypospadias surgical corrections. He operates children with hypospadias at his centre @ Hypospadias Foundation at Kharghar Navi Mumbai, at MGM & Fortis Hospitals in Vashi, at Fortis Hospital in Mulund, Mumbai and at Jupiter Hospital in Thane.

Dr A.K.Singal during Hypospadias surgery

Please feel free to write to us for an opinion at hypospadiasfoundationindia@gmail.com or fill this contact form http://hypospadiasfoundation.com/contact-patient.htm

Watch videos on our Youtube Channel:

https://www.youtube.com/watch?v=HGRDZGXlffY

https://www.youtube.com/watch?v=M9_buN10lUE

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Tag Archives: hypospadias repair surgery

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation