hypospadias surgeon India Archives - Hypospadias Foundation

January 01 2020

Is foreskin reconstruction possible in hypospadias?

Hypospadias Foundation starts Clinic for Hypospadias Treatment & Surgery in Bahrain

Hypospadias is a common urological problem seen in children. The characteristic feature in hypospadias is excess foreskin on the front side of the penis with absent foreskin on the underside with abnormal position of meatus. The common procedure for hypospadias involves using the excess foreskin on the front side of the penis to reconstruct the urethra(urethroplasty). Hence post urethroplasty the penis has a circumcised look.

One of the most frequent questions which Parents ask is – Can the foreskin be reconstructed and retained during urethroplasty and avoid circumcision?

Well the answer is not so straightforward. Traditionally hypospadias repair aims at bringing the meatus to the tip with circumcision as a part of the procedure. But in some cases, with newer techniques, preservation of prepuce is a possibility but not in all the cases.

Case selection is crucial when we consider foreskin preservation and reconstruction (preputioplasty) because it is associated with its own set of complications. Expectation of parents should be discussed prior to considering this procedure. The ones who do not want a circumcised look of penis for their child, we tend to offer prepucioplasty provided the procedure is possible. Hence in a few selected cases of hypospadias circumcision may be avoided. We at hypospadias foundation have operated a few cases of distal hypospadias and foreskin reconstruction(prepucioplasty) was successfully done in these children.

Here are some of the common questions/answers about foreskin reconstruction which will help the parents to know more about foreskin reconstruction in hypospadias.

What is the procedure of foreskin reconstruction?

Reconstruction of foreskin is called “prepucioplasty”. Following urethra reconstruction- “urethroplasty”, the prepuce is incised and closed in 2 layers- outer and inner skin separately.

What is the procedure done when we do not want foreskin reconstructed?

When prepucioplasty is not possible we rotate the excess foreskin from the front side of penis and use parts of it to reconstruct the urethra(urethroplasty). Following this procedure, the penis looks circumcised.

Which cases are ideal for foreskin reconstruction?

Children with minimal defect of foreskin on the underside of penis, distal hypospadias with no abnormal curvature (chordee) of the penis can be offered foreskin reconstruction. This procedure can be considered in parents who want to avoid circumcision for their child.

When do we avoid foreskin reconstruction?

Pre- operatively if the hypospadias is of moderate or severe type and if the foreskin defect is significant then we do not consider foreskin reconstruction. During the surgery if the curvature of the penis(chordee) is found to be significant we tend to avoid prepucioplasty.

What is the postoperative follow up in cases of foreskin reconstruction?

Following foreskin reconstruction in hypospadias, the catheter will stay for 7-10 days. During follow up, we advise the parents to gently start retracting the prepuce after 3 weeks and apply a lubricating antibiotic gel. We advise parents not to retract the foreskin at home in the initial few weeks. Following 4 weeks after surgery, we advise application of a steroid cream for a period of 4 weeks to prevent secondary adhesions.

What are the complications of prepucioplasty?

Prepucioplasty is associated with its own set of complications. Early complications of prepuicoplasty involves prepucial dehiscence or incomplete retraction of the prepuce. Late complications involve secondary phimosis. Developing a fistula is also a known complication because of inability to provide dartos cover for the urethroplasty.

Here are the pre- and post-operative images of Master AP, 7-month child who underwent distal hypospadias repair with prepucioplasty.

Notice the ventral defect in prepuce is small in this case of distal hypospadias

Completed Foreskin Reconstruction (prepucioplasty)

About Hypospadias Foundation:

Hypospadias foundation is a centre which provides personalized care for children and adults with hypospadias. It is the best hospital centre in India and world for surgical treatment for hypospadias in adults and children. Our dedication in the field of hypospadias has helped us achieve excellent outcomes in these patients. We treat children and adults not only from various parts of India but also from more than 25 countries all over the world. Hypospadias foundation is located at MITR hospital in Kharghar, Navi-Mumbai, Maharashtra, India. Every year more than 200 surgeries of hypospadias are performed at MITR hospital.

Dr A K Singal and Dr Ashwitha Shenoy are expert surgeons for Hypospadias in India. Working together as a team they have achieved excellent outcomes in primary and failed hypospadias in children as well as adults.

For appointment with Dr Singal or Dr Shenoy, kindly contact us at the contact details given below.

MITR hospital & Hypospadias Foundation, Kharghar, Navi Mumbai, India- Call for appointments: +91-2227743558/ 27744229/ 39/69 and +91-9324180553.

MITR Clinic: C1/8 Ground floor, Sector-2, Vashi, Navi Mumbai, India – Call: +91-9324502572

July 07 2015

A little boy from Bangladesh takes a little bit of India with him: Successful Distal Penile Hypospadias Repair Surgery in Navi Mumbai

We are privileged to care for children from across the world who come with their parents to our Hypospadias centre in Navi Mumbai, India looking for the best in Hypospadias surgery and treatment. The love and affection which we give to the kids is a mirror image of the trust and faith which family puts in us. It is the simple rule of medical care and cure.

Happy kids= happy parents = good results= happy surgeon who sleeps well. Our nurses and junior doctors almost adopt the kid as one of theirs and then play with the kid during recovery time and we see that with such a personalized care the kids recover after hypospadias surgery in no time.

Somebody said it aptly, “When you are happy the time flies very fast”. Hence, if everyone remains happy and in high spirits after a hypospadias surgery, time just disappears. Long journey to India and time spent here seems worthwhile.

The Email from Dhaka, Bangladesh:

Dear Sir,

Here is our testimony. As you know we are from Dhaka city in Bangladesh and when our son, baby Satyaki Sarkar, was born, he had a problem which the doctors named distal penile hypospadias. So when doctor told us about this problem we were very worried. We didn’t know what to do because we never heard the name of such type of problem. I searched in internet about the problem for best doctor for hypospadias. After searching internet we got the address of Dr. Arbinder Singal, Hypospadias specialist surgeon and Hypospadias Foundation in Navi Mumbai, India. We also watched the video of hypospadias repair surgery which they had uploaded related to surgery about hypospadias of a baby. We also studied the articles of Dr. Singal and others hypospadias surgeons around the world. After that we finally decided to do the hypospadias repair surgery in Navi Mumbai India, at MITR Hospital & Hypospadias foundation. We contacted with the authority of Hypospadias foundation for getting appointment. Ms. Emily Paul and Dr. Rajkumar Gupta arranged appointment for us in a cordial way.

Now it was time for hypospadias surgery. We met with Dr. Singal on 21st March. He appointed us on 23rd March for operation. We were so tensed about Satyaki’s operation. But Dr. Singal and his team were so cooperative that we forgot about all tensions and focused only on Satyaki’s operation. At last, on 23rd March, 2015, the hypospadias operation was done successfully without any problem. After having surgery we stayed in the hospital for one day and the next day they discharged us. After having surgery we felt that we came in the right place because my baby had no surgical pains. He recovered so quickly that we couldn’t imagine. We realized that best results are possible after hypospadias surgery.
We would like to specially mention about the nurses and staffs of hypospadias foundation. They were so cooperative, and cordial. They can manage the babies with hypospadias after surgery in a very caring and professional way.
Now my little boy is completely recovered and doing well without any problem. You may post the picture of my baby and us which you have to us. Because we think that this may help to realize the families that hypospadias problem may be solved through proper surgery. We also think that through our message and picture many families who are suffering from this problem will get new aspirations and hope.
At last we again want to give thanks to Dr. Singal and his team for doing this surgery in an excellent way. We wish success of this foundation in every step of its life.
With best regards

Sanjeev Kumar Sarkar
Father of Satyaki Sarkar
Dhaka, Bangladesh.

Satyaki Sarkar after successful hypospadias surgery with his family and Dr Singal

Case Details: Master Satyaki had a coronal hypospadias, a variety of distal penile hypospadias. He did not have any chordee and his urethral plate was good quality. Hence, we elected to perform a TIP (Tubularised Incised Plate urethroplasty, also called Snodgrass repair). The surgery was completed in one hour’s time and Satyaki was allowed feeds two hours after surgery. He recovered well from anesthesia and surgery and was planned for discharge the next day. In the usual course of family living nearby, we could have sent him home the same day also but since the family had travelled all the way from Bangladesh we kept them in hospital for overnight observation and then they shifted to a nearby hotel. Hypospadias dressing and catheter was removed 5 days after surgery and a final examination done 10 days later showed everything to be well healed and Satyaki was passing urine very well from his new opening at the tip of penis. Now at three months after surgery, Satyaki continues to do well and surgical team is delighted with the outcome of surgery.

While most of families may be little concerned about sharing their personal details etc, Mr Sarkar was very gracious and himself offered to share pictures and details to lend authenticity to the story. He felt this will encourage the parents to think positively about hypospadias treatment in their children. Our endeavor at Hypospadias Foundation of providing good personal and surgical care to children stands fulfilled when we get testimonial and review emails like this one.

About Hypospadias Foundation:

Hypospadias Foundation is a centre of excellence for treatment of children and adults having hypospadias. The centre is located within MITR Hospital at Kharghar, Navi Mumbai India and is the best hospital for treatment and care for patients with hypospadias and associated problems including DSD. The team is led by Dr A.K.Singal, a renowned Pediatric urologist surgeon and an excellent hypospadias surgeon. He is supported by Dr Manish Dubey who helped Dr Singal start Hypospadias Foundation and is himself a renowned Urologist. Every year more than 200 kids and adults travel to Navi Mumbai for care and treatment of Hypospadias. If you wish to contact us, you can write to us at hypospadiasfoundationindia@gmail.com or call Dr Rajkumar, Coordinator for Hypospadias Foundation at +919821261448 between 10am-5pm, India time.

You can also click here and fill up the contact form and we will answer your query as soon as possible

Watch Video of Distal penile Hypospadias repair procedure by Dr A.K.Singal

Watch Video of proximal penile hypospadias procedure by Dr A.K.Singal

Watch Video of severe scrotal hypospadias repair 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)

April 04 2015

From Dhaka, Bangladesh to Navi Mumbai, India: In search for a cure – Story of Adult hypospadias repair surgery

Mr T.R., now 30 years old, was born in Dhaka city in Bangladesh with a urological anomaly called Hypospadias in which the urinary opening is on the underside of the penis rather than the tip. Hypospadias also leads to a downward curvature of the penis called Chordee. Hypospadias always needs surgery, a specialized procedure called Urethroplasty which is done by trained Pediatric Urologist surgeons in childhood itself. Unfortunately, due to lack of awareness and non-availability of Pediatric Urologist doctor in Bangladesh, his parents did not get any surgery done for him. Mr T.R. was a good student and did postgraduate in commerce and got a job with an international bank. He had always thought something was abnormal with his penis and hence started searching for specialist doctor for hypospadias surgery. He found out about Bumrungrad hospital in Thailand and Hypospadias Foundation at MITR Hospital in Kharghar, Navi Mumbai. He sent his medical records to both the places but after exchanging a few emails with Dr A.K.Singal, Pediatric Urologist who managed Hypospadias Foundation, decided to travel to Navi Mumbai for his treatment. He came to Kharghar in September 2014 and after a few tests for fitness for surgery and anesthesia underwent Urethroplasty surgery under care of a team of two surgeons: Dr A.K.Singal, Pediatric Urologist and Dr Manish Dubey, Adult urologist. This is the same team which started Hypospadias foundation 6 years back. The whole surgery was performed in one stage and took three hours. T.R. also had a significant chordee and chordee correction surgery was done at the same time as hypospadias repair procedure. He was discharged to hotel in 2 days. Mr. T.R. recovered well after surgery and the catheter was removed after 14 days. Initially he had a little difficulty in passing urine but settled over the next few weeks. He has sent us reports of uroflowmetry from Bangladesh and they show a good urine flow of urine from the tip of penis.

Dr Singal said “Hypospadias is one of the most common birth defect in children but due to stigma attached to penile deformity no one talks about it. About 1 lakhs kids are born in India every year with this problem and ideally they should be operated by 1.5 years of age. There are an estimated 5 lakh adults and failed hypospadias surgery cases who are suffering and unable to get a cure as the surgeries 20 years back did not have such good results as we have now. Dr Manish Dubey and I started Hypospadias Foundation in 2008 as these children and families need lot of counselling and psychological support beyond surgery for full cure. Also the surgery is difficult and complicated, requires lot of patience and skill, and unless the surgeon is focused on taking this complicated issue head on, the results remain suboptimal. At hypospadias Foundation, we provide hypospadias treatment to more than 200 such children and adults every year and they come from all over India and from countries all over the world. Hypospadias Foundation remains world’s first and only organisation dedicated to caring for children and adults with hypospadias.”

Dr Manish Dubey said “We see lot of adult patients with issues from failed and un-operated hypospadias who come with psychological, infertility and urological issues. They don’t even know where to go for treatment and who is the right doctor for them as this is child urological abnormality which was not treated appropriately many years back. Here at Hypospadias Foundation, our team, does dedicated treatment to make sure that they recover on all aspects and become normal again.”

Dr Singal added “Adults take longer time to heal after hypospadias surgery. Coupled with spontaneous erections which occur in certain phases of sleep, it is little painful for initial few weeks. Over all the healing may take upto 2-3 months though one can join back work in 3-4 weeks after adult hypospadias surgery.

Mr T.R. said “I did a lot of research on internet before deciding to go to Navi Mumbai India for my hypospadias surgery. The focus and dedication with which Dr. Singal and Dr. Dubey manage patients with hypospadias is good to see. I am very thankful to Dr. Rajkumar also who took personal care for me when I was recovering. Besides, I found the full team of MITR is so helpful and caring that I didn’t feel uncomfortable during my stay. Especially I should have mentioned the name of Mrs. Emily who is an administrator of MITR Hospital, helped me a lot in every single stage with lovely smile. In terms of my treatment, I found Dr. Singal is very friendly and always listened me with lots of care. His hands on experience and depth of knowledge on this particular field makes him so confident which I liked most. Before my surgery I knew that hypospadias treatment on adult is so complicated thus I was in strain but after meeting Dr. Singal before my surgery made me so relaxed. After my surgery I felt complication while passing urine but Dr. Singal and Dr Dubey immediately managed the situation and solved the problem. Overall, it’s an excellent experience doing my surgery by Dr. Singal. I would strongly recommend Dr. Singal if anyone has been suffering from hypospadias in the adult stage. I would like to congratulate Dr. Singal and his team for doing the outstanding jobs. Wish the team all the very best.”

About Hypospadias Foundation:

Hypospadias Foundation is a part of MITR Hospital in Kharghar, Navi Mumbai, India and registered as a NGO under One Vision Health and Research Foundation. It was started by Dr A.K.Singal and Dr Manish Dubey on 26 Nov, 2008 and has to date treated more than 1000 kids and adults with hypospadias. Patients have come from virtually all states and major cities in India for Hypospadias treatment in Kharghar. Patients have also traveled from countries like Nigeria, Congo, Tanzania, UAE, Kuwait, Qatar, Greece, Nepal, Pakistan and Bangladesh.

Hypospadias Foundation aims to make sure that no child or adult is said no for surgery because of shortage of money or intent. Also, Hypospadias surgery training programs are planned in near future to train more surgeons to take care of Hypospadias Patients in a just, ethical and compassionate way.

Hypospadias Foundation was covered by yourstory.com, a leading online portal:

http://social.yourstory.com/2015/01/hypospadias/

Dr A.K.Singal during Hypospadias surgery

To get in touch with us please write to hypospadiasfoundationindia@gmail.com or fill up this contact form: Contact Hypospadias Foundation

Videos of Hypospadias repair surgery by Dr A.K.Singal

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

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