Why nobody talks about Hypospadias?

Hypospadias is a condition where the urinary opening instead of being present at the tip of penis lies somewhere on the underside of penis. There may be an associated downward curvature of penis (called chordee) as well.

Hypospadias is a common disorder, yet it never gets much public attention. If we just talk about the hardcore data – it is staggering!!

1/200 boys has hypospadias and this translates to 30 lakh (3 million) Indians (both adult & children) having Hypospadias which has either got treated, ignored or there have been failed attempts at repair. Every year there are more than 75000 kids born with hypospadias in India. Multiply this by 4 and you will get the global scale of the problem.

Inspite of millions of kids having hypospadias and recent reports showing an increasing incidence because of various environmental factors, it is shocking that so little has been done to help children with hypospadias. Right from creating awareness about hypospadias to dispelling myths about Hypospadias and then leading on to supporting these children in younger age with proper diagnosis, timely surgery, evaluation for associated issues and then making sure that they develop into productive citizens of the society – this is a massive task. It requires motivation, commitment and understanding of the complex interplay both from the medical personnel as well as the parents of the child.

Maybe hypospadias affects the male organ, putting parents and family under pressure to hide the disorder and everyone is worried about the stigma a penile abnormality carries even if repaired. Having seen numerous children with Hypospadias and their families, I understand a bit of their side. This will improve only when society starts thinking of Hypospadias or for that matter any disorder affecting the reproductive system as a small aberration and that too fully correctable with latest treatments.

With growing experience, instrumentation, commitment and requisite team building, the results of hypospadias surgery are better than before. Hypospadias correction or Urethroplasty gets performed before infancy is over, most of the children go home the day of surgery in their diapers and success rates of a single stage urethroplasty are more than 95% over all varying from almost 99% in distal hypospadias to 90% in proximal hypospadias.

It takes years for a surgeon to hone skills which will provide a predictably good result and a standard of care. This may involve first, a medical school training (5.5 years), General Surgery training (3 years), Specialist surgery training in Pediatric Surgery (3 years) and then a Pediatric urology training (1-2 years) – so a long haul of 12 plus years and that’s not it. It takes a further of 1-2 years to establish a centre and then train the ancillary staff for managing these children.

During training when I saw the hypospadias surgery for the first time, I never thought that I would get so attached to caring for children with hypospadias. The surgery was difficult, required immense concentration for a prolonged period of time with magnification glasses and fine instruments, and still the results were suboptimal. It all changed during my Pediatric urology stint at Nationwide Childrens Hospital, Ohio-USA with Dr Rama Jayanthi. Suddenly, hypospadias was no longer a mathematical impossibility. It seemed possible to get predictable results after all and see happy kids. From then on there has been no looking back.

Operating on a child with hypospadias is still the most important task for me and it something I look forward to doing every day. It is like meditation, first surgery in the morning. Everybody is ready, the team is motivated about making a difference to a little kid and then we do our jobs with precision and in sync at MITR Hospital and Hypospadias foundation. The staff is trained in pre-operative and post-operative care.

Infact it has been the dream of my closest friend, colleague and co-founder of Hypospadias foundation – Dr Manish Dubey to see kids walking around the hospital with pink bandages on their penis and balloons in their hands and, we made it come true last year on Childrens day (14 November) when we operated 3 kids with hypospadias in a single day.

Inside everyone lies a hope, a positive current which carries us forward through our life. We also believe that with better management of the hypospadias on clinical as well incidental issues around it, the stigma around hypospadias will go away completely. The final calling will be when we see these young kids develop into normal citizens and raise their own families and hopefully invite us to attend their weddings.
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