Distal penile hypospadias repair in single stage in a 11-month baby

Case 1: Distal penile hypospadias repair in single stage in a 11-month baby

Mast AA, 11 months old male child came to hypospadias foundation with complaints of abnormal urinary opening on the underside of the penis. On examination, the urethral opening was noted just below the head of the penis with incomplete prepuce. There was associated abnormal curvature of the penis which is called as ventral chordee with short skin on the underside of the penis.

Mast AA was planned for single/staged repair based on the degree of chordee. A stay stitch was taken on the penis. Incisions were marked and complete degloving of the penis was done. Degloving of the penis was done with division of bands under the skin. We proceeded to check the chordee by artificial erection test. No chordee was noted. Since chordee was corrected post degloving, we proceeded with urethroplasty.

TIP incision was given in the urethral plate as a step towards TIP urethroplasty. Tourniquet was applied at the base of the penis. Incision was given on the glans to raise the glans wings. The urethroplasty was done over a 7Fr urinary tube with absorbable 6-0 PDS suture. A new urinary opening was created at the tip of the glans. Dorsal prepuce was divided in the midline. Flap was raised from the dartos tissue of the prepuce for second layer coverage of the urethroplasty. Glansplasty was done by approximation of glans wings. The prepucial skin was rotated to cover the underside of the penis.

We removed the hypospadias dressing on post operative day 7 along with the urinary tube. Child passed urine in straight stream after urinary tube removal. The hypospadias surgery site healed well with no complications. At 3 months check-up after hypospadias surgery, the child is passing urine well with no discomfort. The parents were glad to see the result of hypospadias repair surgery.

Pic 1: Clinical examination in the preoperative period showed congenital defect in the prepuce with distal penile meatus

Pic 2: Complete degloving done and artificial erection test performed. Penis was straight with no chordee.

Pic 5: Cosmetic result at 1 month after surgery

Pic 3: Glans wings widely raised, distal urethroplasty and Glansplasty done

Pic 4: Skin sutured in 2 layers using 6-0 PDS and 6-0 vicryl rapide

Pic 5: Cosmetic result at 1 month after surgery

Distal hypospadias repair in single stage

Distal penile hypospadias is a condition in which the opening is situated on the underside of the penis. Surgical correction is generally performed in early childhood typically between 6-18 months of age to minimize the psychological and functional effects as the child grows. Tubularized incised plate (TIP) urethroplasty is the most common technique used for distal hypospadias. This technique was used in the above-mentioned case and the new meatus is created at the tip of the penis and prepucial skin is used to cover the newly formed urethra.

Distal penile hypospadias surgery result is excellent with low complication rate at centres with expertise in hypospadias repair. Early intervention is the key to achieving optimal results, both functionally and psychologically, as it allows the child to grow up without the stigma of the condition.

Hypospadias foundation is located at MITR hospital, Kharghar, Navi Mumbai is a centre dedicated to providing comprehensive care, support and educational resources for individuals affected by hypospadias. They focus on raising awareness, promoting early diagnosis and offering access to specialized treatment for children and adults with hypospadias.

Hypospadias foundation is recognized for its high success rate in the repair of hypospadias, with many patients experiencing positive results. They are particularly known for handling complex and failed hypospadias cases. The success often exceeds 90-95% in correcting both functional and cosmetic issues.

Dr A.K Singal is a key figure at the Hypospadias Foundation is considered the best hypospadias surgeon in India and the world. He specializes in pediatric urology and is particularly renowned for his work in hypospadias through his innovative surgical techniques. He has treated thousands of patients with hypospadias and other urological disorders consistently achieving high success rate.

Dr Shenoy is recognized for her work with children providing care for children with hypospadias and other urological disorders. Dr Shenoy along with Dr Singal has significant experience in diagnosis and surgical correction of hypospadias. They use state of the art techniques to ensure both function and cosmetic success in their surgeries.