hypospadias surgery india Archives - Hypospadias Foundation

April 04 2015

Chennai to Navi Mumbai: A Doctor’s tale of Hypospadias Repair Surgery for her son

As doctors we are blessed to earn both money and gratitude from our patients. This is even better for us Pediatric urologists as we can experience deep happiness of the parents when their little one gets better after a surgery. We personally feel that we are a part of their life now as we were the lucky one’s to be there when they were struggling to get their little one through a difficult time such as surgery. God has given such unique position to doctors caring for kids as they can then see kids growing up year by year and feel blessed to have invested their life into building up a healthy and safe future.

The diagnosis of hypospadias in a newborn baby can cause a lot of anxiety, distress and pain to the mother who has just delivered, the husband who hasn’t slept in days and the family which has keenly waited for 9 months. At this time in first few days of life, if a proper counseling and guidance can be given by an expert, it can make a world of difference. This may not be possible all of the times as surgeons caring for children with hypospadias on a very dedicated basis are far and few in between across India. Most of the pediatric urologists and surgeons are adept in diagnosing, understanding and counseling for hypospadias and hence should be called in neonatal age itself.

One year back, I received a call from neonatal nursery to see a newborn baby born with hypospadias. Both mom and dad were doctors and worked in Chennai, Tamilnadu, India. Mother was delivering in a Navi Mumbai hospital as the maternal side family lived in Vashi. During the visit, I could see the anxiety and concern writ large on her face. She was torn between playing her role as a mother and her knowledge as a doctor. I discussed with her in detail about the type of hypospadias and also the corrective surgery needed. Since it was a midpenile hypospadias, I told them that a single stage urethroplasty repair was possible. We discussed at length about the right age for surgery and anesthesia. The baby and mother were discharged from nursery at 3 days and then I saw them again at 1 month of age, By this time, the mom was mentally tough and ready for the surgery. We planned the surgery at 6 months of age.

The family travelled from Chennai to Navi Mumbai at 6 months of age with a preplanned date for surgery. Since the urethra was hypoplastic for a short distance proximally and the urethral plate was not very good, we did an onlay island flap repair. The surgery was completed in 2 hours and A.J. was discharged the next morning. The hypospadias dressing was removed on day 5 and the urinary catheter was removed on day 10 after surgery. A.J. healed well over next 2 weeks and the family visited me again 6 months after surgery. A.J. is passing urine from tip of penis, the penis is straight and there is an excellent cosmetic result of his hypospadias surgery. The family is overjoyed and I am also relieved and happy with the good outcome.

The mother sent us a nice thank you note last week and it made my day. It follows verbatim here:

Hello Dr. Arbinder Singal,
A happy parent with a blessed son.
First I would like to convey my heartily thankfulness for your key role in my life. I would rather tell it as my life because my son is my life.
October 2012, good news was accompanied with sad news too, when my pediatrician told me that my son is suffering from hypospadias. Even though I am also a doctor, a fearful alarm rang inside a mother with loads and loads of questions.
But to my rescue doctor, your opinion was asked. During your visit, you were polite and calmly answered all my questions and relieved my fears.
As I am from Chennai and my parents stay in Chennai, everything fell in place very conveniently.
After 6 months, the day for hypospadias surgery came, as doctors, my husband and I were ready mentally but emotionally it was a nightmare.
But thank you doctor, MITR doctors and staffs- All made us feel very comfortable. You were so supportive and took care of everything right from the beginning.

That day gave a new life to my son. Now he is doing fine and leading a happy and normal life.

Six months have passed and everything is well.

Thank you God
Thank you doctor
Thank you MITR Hospital and staff
Thank you Hypospadias foundation
May your sincere service continue forever for the needy.
God bless you
Yours
A happy parent with a blessed son

Footnote:

These are the letters and emails which make caring for kids worthwhile even in the face of all risks and uncertainties of surgery on a small child. In the dark times, these blessings shine like rays of hope and give energy to carry on. I wish to express gratitude to all parents who have trusted us with the care of their little ones. We feel truly blessed and honoured to be of help.

About the author:

Dr A.K.Singal is a Pediatric Urologist and a specialist hypospadias surgeon. He does more than 200 hypospadias repair surgeries every year and has the best results for complicated and failed hypospadias. Every year he gets referred complex, severe and failed hypospadias patients from all over India and more than 20 countries. Along with the team at Hypospadias Foundation and MITR Hospitals, he feels joy and blessings in caring for children with hypospadias.

You can send us an enquiry by filling up this form: http://hypospadiasfoundation.com/contact-patient.htm

Or you can send us an email at hypospadiasfoundationindia@gmail.com

Or you can call Dr Rajkumar, Coordinator of Hypospadias Foundation, at +91-9821261448 between 10am-4pm

Also, you can call up Dr Rajkumar, Dr Singal’s assistant and Coordinator of Hypospadias Foundation on +91-9821261448

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

February 02 2015

Boy from Congo (Africa) finds cure for Distal Penile Hypospadias in Navi Mumbai, India- Successful hypospadias repair surgery even after circumcision

Hypospadias is the most common urological anomaly (birth defect) seen in newborn babies worldwide. It is mostly diagnosed soon after the baby is born when the opening of for urine is seen to be on underside of penis, the foreskin (prepuce) is incomplete on the underside and there may be a bend in the penis (chordee). Very rarely, if the hypospadias is very mild, it can be missed on neonatal examination by even a pediatrician.

Lot of countries and religions practice and advocate newborn circumcision in all male babies but whenever hypospadias is diagnosed in newborn age, circumcision should not be done. During circumcision, the prepuce is cut off and a very vital tissue which is required for hypospadias repair surgery is lost. Prepuce or its layers are used for anatomical hypospadias correction surgery. In a circumcised boy, hypospadias repair becomes difficult and complication rate of hypospadias surgery is little higher.

Master K.Hadriel.Ileunga was born in Congo (Africa) in a small city. His doctor did not recognize at birth that he had a distal penile hypospadias. He underwent a circumcision in the first few days of life by a general practitioner doctor. Later his parents and doctors realized that Hadriel had a distal penile hypospadias. As he grew up in Congo (Africa) his parents worried about his hypospadias. They visited a few doctors in Congo but there was no pediatric urologist available in Congo who could do a hypospadias repair after circumcision. At this time, they learnt about Hypospadias Foundation in Navi Mumbai, India and sent an email to come and get treated under Dr A.K.Singal’s care, one of the most renowned pediatric urologists and the best Hypospadias Surgeon in India.

Finally in first week of Jan 2015, the family met Dr Singal in Navi Mumbai. On examination, Hadriel had a distal penile hypospadias without chordee. There was no prepuce as he had undergone a circumcision in newborn age. After discussing with the parents, Hadriel was taken up for Hypospadias repair surgery on 16 Jan 2015. The surgery was done using Tubularised incised plate urethroplasty – also called Snodgrass urethroplasty. The whole urethroplasty was completed in one stage. The child was discharged from hospital the next day and the hypospadias dressing was removed after 5 days. The urethral catheter was removed after one week of surgery. Hadriel passed urine in very good stream without any difficulty. After a final follow-up two week after surgery, Hadriel has gone back to Africa- his country Congo and family is very happy. Fortunately, he had an excellent result of hypospadias repair surgery even after a neonatal circumcision.

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Dr A.K.Singal with Hadriel, hypospadias patient from Congo

Watch Video of Single stage surgery for severe scrotal hypospadias by Dr A.K.Singal, Hypospadias specialist surgeon

Contact Form for Hypospadias Foundation

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

January 01 2015

Family travels from England (UK) for Hypospadias repair surgery of their child to Navi Mumbai, India

Hypospadias remains one of the most common urological anomalies across the globe affecting almost 1/150 newborn boys. No nation or economic status or religion is exempt from its occurrence. The art and science of hypospadias treatment has evolved significantly in the last two years with a single stage repair of hypospadias a real possibility in most of the cases. The results of hypospadias surgery are of course better at centres where there are specialist hypospadias surgeons doing dedicated hypospadias treatment in large numbers every year. Even the complications of hypospadias surgeries decrease significantly with increasing experience. This was the aim with which we started Hypospadias Foundation in 2008. Now 6 years later, we are happy to provide excellent outcomes and give happiness to kids and families who travel to India from all over the world.

The Child from Great Britain

Master Narain was noted to have hypospadias as soon as he was born in England. The pediatrician advised the family to meet the pediatric surgeon or pediatric urologist when the child was three months old. Through the NHS system, the family went and met a Pediatric Surgeon who advised hypospadias repair surgery after 1.5-2 years of age.

Mother and father, both UK residents, were worried about delaying the surgery so much as somehow they felt that once the surgery is needed they better get it done at a younger age than a later age. They just couldn’t understand the point of waiting for the surgery which would anyway be required. With this dilemma about the age for hypospadias surgery, they contacted us at Hypospadias Foundation. After a few tele and online consultations they decided to travel to India for Hypospadias repair surgery with us at MITR Hospital in Navi Mumbai, India. We advised surgery between 6 months to one year of age. Finally, when Narain was 9 months old they traveled to India from England and visited us.

On examination, Narain had a distal penile hypospadias without any chordee. The urethral plate was pink and healthy and he seemed suitable for a single stage Hypospadias repair. Parents did not have too many questions and I was very surprised. When I asked, they said that they have read a lot of blogs written by me on hypospadias treatment and were upto date with what their son is going to go through. This was a very happy consultation indeed. Saved me time and energy but still I went through the pre and post hypospadias surgery routine with them explaining to them. They just nodded their heads and posted Narain for surgery one day later and meanwhile we got the blood/ urine tests and pre surgery fitness for anesthesia.

Surgery was done as first case in the morning the following day. Surgery was done under caudal analgesia and sevoflurane anesthesia. Since the urethral plate was good and the hypospadias was not very severe (distal penile hypospadias), we did a Tubularised incised plate urethroplasty also called Snodgrass repair urethroplasty. The surgery took only 75 minutes. Narain tolerated the procedure well and was to his usual playful self in a few hours after surgery. We sent him home by the next morning on usual oral medications for pain and bladder spasms and a mild antibiotic. One week later, the family visited us again in the outpatient clinic for removal of dressing and catheter. Narain passed urine well without any issues and had a good healing operative site at the time of hypospadias dressing removal. Another followup was scheduled at 10 days after catheter & dressing removal. Narain was passing urine in a good straight stream without any difficulty. Also the cosmetic result was excellent. The family was overjoyed and was able to travel back to England within three weeks of surgery. We requested the family to send us a short video of Narain passing urine and a few pictures of his penis at about 6 weeks and 3 months after surgery to confirm that everything has healed without any complication. We received these videos and pictures a week back and were happy to note that there was no complication of the surgery. We expect Narain to do very well and live a normal life after the hypospadias surgery.

About the author:

Dr A.K.Singal is a renowned Pediatric urologist and is considered one of the best hypospadias surgeons in India. He treats more than 100 kids with hypospadias every year at various hospitals in Navi Mumbai, Thane and Mumbai. Lot of kids travel from neighbouring cities such as Pune, Ahmedabad, Surat, Goa and as far as Bangalore, Hyderabad, Calcutta, Delhi, Jaipur, Chennai etc.

He can be contacted by filling up the form here: Contact form Dr A.K.Singal

Dr A.K.Singal during Hypospadias surgery

Watch Video of Distal Penile Hypospadias Repair Surgery by Dr A.K.Singal, expert hypospadias surgeon

Watch Video of Single stage surgery for severe scrotal hypospadias by Dr A.K.Singal, Hypospadias specialist surgeon

Contact Form for Hypospadias Foundation

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

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)

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Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation

Contact Form for Hypospadias Foundation