Hypospadias
Hypospadias
Hypospadias
Hypospadias is a birth disorder where the urinary opening (pee hole) is located on the undersurface of the penis instead of at the tip of penis. Hypospadias may be of varying severity depending on where the opening is. In the mildest form (glanular hypospadias) is on the glans slightly short of tip. In moderate hypospadias, the opening is where the glans meets the body of the penis (coronal and sub-coronal). Urinary openings farther back (on the penis itself or at the base of the penis) are so called the severe varieties. In addition to the hole being in the wrong place, the foreskin is often incomplete on the undersurface and looks like a hood on the top. In severe cases, the penis is bent downwards (chordee) usually due to tight skin or sometimes due to abnormality of the body of the penis.
Incidence & other factor
Hypospadias occurs to some degree in 1 in 150 to 200 boys. In India every year more than 75000 babies are born with hypospadias and need to see a pediatric urologist. Mild to moderate hypospadias are generally not associated with other abnormalities so further tests are not required. If the hypospadias is of severe variety or an undescended testis or the penis is small, then further testing is required.
Etiology & pathogenesis
The urinary pipe within penis (called urethra) normally forms from a strip of special skin forming itself into a tube on the underside of the penis. It closes up like a zip fastener from the back end to the tip of the penis. For some reason, in children with hypospadias the last part of the tube fails to form and it remains incomplete. The underlying cause is not known in most cases. There are several theories including increased hormone disruptors which are female hormone like substances causing mild forms of hypospadias. Very occasionally it seems to run in families.
Role of Surgery
Surgery may be required for 2 reasons:
a) To make everything work properly, i.e. to make the urine comes out straight and to make the penis straight.
b) For cosmetic reasons.
If the boy can pass urine forwards and the penis is straight then the operation is purely cosmetic. Untreated hypospadias can lead to psychological disturbances. Surgery is best done in the first year of life.
Ideal age for Hypospadias repair (Urethroplasty)
Ideal age for surgery in most of the hypospadias is between 6-12 months of age. If there are any co-existing problems then surgery may be delayed till they are sorted out.
Anesthesia is relatively safe in children after 6 months of age, that’s why it is better to wait till that age. In infancy the babies are still in diapers, so postoperative management is very easy at hoe by the parents. The catheter is left to just drip into the diapers and baby can be sent home the evening of surgery or maximum the next day. Also, penile skin and tissues are very soft and heal very well at young age. Most importantly, erections and infections are less of an issue at such a young age.
Precautions before surgery
Babies are checked for fitness for anesthesia by a pediatrician/ anesthetist. A couple of blood tests may be required. Any history of bleeding/ blood disorder in the family should be checked. The baby should be free from infection elsewhere (cold, cough, diarrhea, skin infections etc.). Before surgery, babies are kept empty stomach for 4-6 hours as it is a requirement for anesthesia. Bathing is advisable in the morning of surgery.
Type & details of Surgery (Urethroplasty)
Surgery time depends upon the type of the hypospadias. Generally total time spent in the operation room (inclusive of anesthesia time) for a hypospadias is between 2-3 hours and this may go upto 4-5 hours for severe hypospadias
There are many types of operations designed to repair hypospadias. Essentially the operations bring the hole up to the correct position on the ‘head’ of the penis (glans), make sure that the penis is straight and looks just like a circumcised penis all in one operation. Many moderate hypospadias repair operations can be done as day care procedures (in and out of hospital the same day). Sometimes the child may need to stay in hospital overnight. There will be a tube (stent) draining the urine for a few days. Further details are explained by our doctor before the child is planned for surgery.
Use of Stent/ Catheter for drainage
At the end of surgery, a tube (stent) is left into the bladder to drain the urine. This is left in place for 5 to 14 days depending on the type of the operation, and simply drains urine into the nappy. A bag can be attached for older children who no longer use nappies.
The catheter is used to prevent pain of passing urine through the recently operated urethra. For a major urethroplasty, catheter may be kept for a longer period to help healing. This catheter may irritate the bladder causing spasms in some cases. The baby will be cranky and irritable at time of spasms. If spasms occur, they can be easily treated by giving a medicine.
Post-operative course & Follow-up
Babies are usually allowed feeds within 3-4 hours after surgery once they are fully awake and looking for feeds. Initially liquids such as water and juices are started if there is no vomiting gradually solids are introduced. Generally, babies are on their usual complete diet the morning after surgery. Double Diapers are used by parents to ease the postoperative care. Medications (syrups) are explained well and discharge happens by evening or morning after.
First follow-up visit is generally after 5-7 days after surgery for removal of dressing. After removal of dressing, an antibacterial ointment is applied 4-5 times a day and also each diaper change. Depending on the type of surgery done, second visit is arranged after 10-14 days for removal of catheter. A further check-up is done after 3-4 weeks, 3 months and at one year.
Common problems after surgery
➾ Most of the time the babies are slightly cranky but manageable with medicines. They feel better at home that is why we try to send them to home as soon as possible. It is also easier for the parents to manage them at home.
➾ Babies may have intermittent bladder spasms due to irritation by the catheter. For this reason a small dose of bladder relaxant medication is usually prescribed. The dose may need to be adjusted if cramps still happen.
➾ Blood spotting in the diaper/ catheter may occur in the first few days. A few drops of the blood are acceptable. In case of continuing bleeding, a hospital visit may be required but this is very infrequent.
➾ Dressing loosening up may occur in some babies, if it happens during first 2-3 days then a new dressing is placed. After that the dressing may just be removed.
➾ Infection may happen and may be most common cause of the failure of surgery. To prevent this, broad spectrum antibiotic syrup is usually prescribed for 7-10 days
Prognosis and long term outcomes
Isolated hypospadias once corrected does not have long-term sequences. Only cases where the hypospadias is very severe or there is associated undescended testis or the gender itself is in question. This can be ascertained by a set of certain investigations which doctors will explain if required.
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Testimonials
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Kranti Tandel
2 months ago
From the moment I walked into the hospital until the day I was discharged, I felt genuinely cared for.
A heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Read moreA heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Shilpa Nair
4 months ago
I had an excellent experience and am very grateful for the care and support I received. The entire staff was professional, friendly, and attentive, making me feel comfortable throughout the process.
A special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Read moreA special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Mahendra Patil
4 months ago
My 3 years 11 month year old daughter was diagnosed with 10 mm kidney stone Dr.A.k.Singhal,Dr.Manish Dubey,and Dr.Ashwita Shenoy performed the surgery to remove the stone on May 30th with immense success. I am deeply grateful for the exceptional care and professionalism demonstrated by this entire team.
From the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Read moreFrom the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Purva Shingare
4 months ago
Had kidney stone surgery done by Dr Manish Dubey. All staff was cooperative. Doctor Dubey made me so much relaxed that I was not at all worried about the procedure. Other doctors in the OT were also very sweet. The staff is very nice, hospital is clean ,no smell of medicines, housekeeping services are very good. Hospital food is also very nice,tasty and healthy. Insurance procedure is also very easy. The surgery procedure went so smoothly. I would surely recommend Mitr Hospital and special thanks to Dr Dubey.
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Nikita Ghodke
6 months ago
I had an amazing experience at the hospital, which offers excellent facilities and truly stands out in terms of care and support. I was under the treatment of Dr. Vijaykumar Yadav, who is exceptional in his field. His kindness, compassion, and dedication to his work made a significant difference throughout my journey.
He is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Read moreHe is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Dimple Choudhary
1 year ago
Very polite staff N great service ☺️
Ketan Bhagat
1 year ago
Excellent,
We had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Read moreWe had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Pankaj Choudhary
1 year ago
Very experienced Doctor and cooperative staff. They give full time to patients for there Query and problems.
Blood test Camp organised for Woman's day was support and very helpful
Read moreBlood test Camp organised for Woman's day was support and very helpful
Sneha Omale
1 year ago
डॉ. अमित घरत इंडॉस्कॉपी खूप छान पध्दती ने केली . धन्यवाद डॉक्टर आणि त्यांची टीम . वेळोवेळी मदत केली बद्दल.
prathamesh palkar
1 year ago
“I am extremely grateful for the excellent service provided by Mr.Aditya Sir from the hospital TPA insurance team. He was incredibly professional, patient, and thorough in explaining my insurance coverage and guiding me through the entire process. His prompt assistance and dedication made everything smooth and hassle-free. I truly appreciate his kindness and efficiency in handling my queries. Thank you, Aditya Sir, for your outstanding support!”
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