Hypospadias

Our Approach In Managing Hypospadias

Precision surgery. Lifelong outcomes. Child-centred care.

Hypospadias repair is one of the most technically demanding procedures in paediatric reconstructive surgery. The goal is singular but multifaceted ,a straight penis with a terminal urethral meatus (urethral opening at the tip), normal urination, and a cosmetically acceptable appearance.

1. Classification & Pre-Operative Assessment

Accurate classification determines the surgical approach:

• Distal hypospadias (glanular, coronal, subcoronal) , most common; single-stage repair
• Mid-shaft hypospadias : may require staged repair depending on local tissue availability
• Proximal hypospadias (penoscrotal, scrotal, perineal)  most complex; often requires staged surgery
• Evaluation for associated anomalies , undescended testes, inguinal hernia, chordee severity

2. Hormonal Pre-Treatment (When Indicated)

For proximal or severe cases where penile size may limit tissue-based repair:

• Pre-operative testosterone cream applied to the penis for 4–6 weeks
• Stimulates penile and prepuce growth , providing more tissue for urethroplasty
• Particularly important for proximal hypospadias in infants with a small glans
• Monitored by our paediatric endocrinology team where hormonal assessment is appropriate

3. Optimal Age for Surgery

Timing of repair is carefully planned for the best anaesthetic and surgical outcome:

• Ideal age for repair: 6–18 months  before toilet training and in the optimal anaesthetic safety window
• Later repair is feasible older children and adults are operated on with equally good outcomes
• Paediatric urethroplasty Mumbai is performed under general anaesthesia with dedicated paediatric anaesthetic support
• Day-care for most distal repairs; short admission (1–2 nights) for mid and proximal repairs

4. TIP (Tubularised Incised Plate) Repair

The most commonly performed technique for distal and many mid-shaft hypospadias:

• Tubularised incised plate repair  the urethal plate on the underside of the glans is incised and tubularised over a catheter
• Single-stage procedure with excellent functional and aesthetic outcomes
• Glanuloplasty performed to recreate a normal conical glans shape
• De-epithelialised flap (TIPU) or dartos flap used to cover the neo-urethra and prevent fistula

5. Chordee Correction

Penile curvature (chordee) must be corrected at the time of hypospadias repair:

• Artificial erection test intra-operatively to assess degree of curvature
• Chordee correction by degloving and excision of fibrous bands if curvature is mild
• Dermal graft or tunica albuginea plication for curvature greater than 30 degrees
• Complete straightening confirmed before urethroplasty proceeds

6. Staged Repair for Proximal Hypospadias

Severe proximal hypospadias often requires two planned stages:

• Stage 1: Chordee correction and graft placement (buccal mucosa or preputial skin) to create a urethral plate
• Stage 2 (6 months later): Tubularisation of the graft to form the neo-urethra and complete penile reconstruction paediatric repair
• Staged approach allows tissues to heal and mature between operations for optimal neo-urethral quality
• Buccal mucosa graft harvested from the inner cheek  superior durability as urethral lining

7. Post-Operative Care & Long-Term Follow-Up

Recovery is structured and well-monitored:

• Urethral catheter left in situ for 5–10 days post-repair , essential for neo-urethral healing
• Penile dressing kept intact for 5–7 days , changed at scheduled clinic visit
• Parents counselled on catheter care, activity restrictions, and signs of complications (fistula, meatal stenosis)
• Follow-up at 6 weeks, 6 months, and annually , voiding assessment and cosmetic review at each visit