Hypospadias is a condition that can be worrying for parents and deeply personal for adults. Every case is different, and treatment is not simply about changing the position of the urinary opening. It may involve correction of penile curvature, reconstruction of the urethra, restoration of normal anatomy and, in some cases, repair of problems left behind after an earlier operation.
At the Hypospadias Specialty Center at Calcutta Cosmo Aid, treatment is provided by a dedicated team of reconstructive surgeons — Dr. Anand Kumar Nagwani, M.Ch. (Plastic & Cosmetic Surgery) and Dr. Janki Bisht Nagwani, M.Ch. (Pediatric Surgery).
The combination of reconstructive plastic surgery and pediatric surgery allows the team to look at each patient as a whole — not just the location of the urinary opening, but the penile anatomy, curvature, urethral tissues, skin, previous surgical history and long-term functional needs.
We care for children and adults with primary hypospadias, including distal, midshaft and proximal forms. We also evaluate patients who have undergone previous surgery elsewhere and are now facing problems such as fistula, narrowing of the urinary passage, recurrent curvature, scarring, wound problems or other complications.
Our approach is personal and straightforward: understand the problem properly, explain the options clearly and then plan the reconstruction according to the patient’s individual anatomy.
Hypospadias is a condition present from birth in which the opening through which urine passes — the urethral opening — is located on the underside of the penis rather than at the usual position at the tip.
The condition can be mild in some children and considerably more complex in others.
It may be associated with:
The position of the opening is only one part of the picture. The overall anatomy is what determines the surgical plan.
In distal hypospadias, the urinary opening is located closer to the head of the penis.
These cases may have relatively limited curvature, although every child needs individual assessment.
Depending on the anatomy, procedures such as tubularized incised plate (TIP) urethroplasty or other reconstructive techniques may be considered.
Here, the urinary opening lies along the middle portion of the penile shaft.
The degree of curvature and the quality of the urethral plate can vary considerably from one child to another.
Treatment may involve urethral reconstruction together with correction of curvature, and in selected cases a single-stage or staged repair may be appropriate.
Proximal hypospadias is generally more complex because the urinary opening is positioned further towards the base of the penis.
It may be associated with:
Depending on the individual anatomy, a single-stage or two-stage reconstruction may be advised.
For some severe cases, a staged approach provides a safer and more controlled way of rebuilding the urethra.
Some children with hypospadias also have chordee, meaning the penis bends downward because of differences in the tissues and structures on the underside.
The degree of curvature is assessed carefully during the surgical evaluation.
Correction may involve release of tethering tissues, urethral plate management, plication or other reconstructive techniques depending on the cause and severity of the curvature.
The aim is not merely to move the urinary opening. The penis should also be appropriately straightened as part of functional reconstruction.
<We do not believe in treating every hypospadias case with the same operation.
The surgical plan is based on:
For selected patients, the urethra and associated anatomy can be reconstructed in one operation.
For selected complex or proximal cases, reconstruction may be divided into two planned operations.
This allows the tissues to heal properly between stages and may provide a better reconstructive pathway when the local tissues are not suitable for a straightforward single-stage repair.
Patients with significant tissue deficiency or previous failed surgery may require more advanced reconstructive procedures, including graft-based reconstruction in selected cases.
At our centre, primary hypospadias surgery is undertaken from 3 years of age onward, following a detailed individual assessment.
We understand that parents often have many questions about timing — Is my child too young? Is it too late? Will the child remember the surgery? Will the penis grow normally afterwards?
These concerns are discussed openly during consultation.
Our centre’s 3+ years protocol is our own treatment practice and should not be interpreted as a universal recommendation for every hypospadias patient. International guidelines may recommend repair at an earlier age in many children.
We also see older children, teenagers and adults who have never undergone treatment or who continue to have functional or anatomical concerns.
Some men reach adulthood without having undergone repair. Others may have had surgery during childhood but continue to experience problems.
Adult patients may present with:
There is no reason to feel embarrassed about seeking help.
A proper assessment can determine what is happening with the urethra, penile tissues and previous reconstruction and whether further treatment may be appropriate.
Some families come to us after their child has already undergone one or more operations elsewhere.
Sometimes the problem is a small fistula. In other cases, there may be significant scarring, recurrent curvature, urethral narrowing or a more complicated failed reconstruction.
For such patients, we first try to understand:
Like any reconstructive surgery, hypospadias surgery can have complications.
Depending on the complexity of the case, these may include:
The risk is not the same for every patient. Proximal hypospadias, significant curvature, poor tissue quality and previous failed surgery can make reconstruction more complex.
We believe parents and patients should know these possibilities before making a decision. The aim is to provide realistic guidance rather than promise a result that no surgeon can guarantee.
We understand that hypospadias involves a very private part of the body.
For parents, there can be anxiety about their child’s future. For adults, discussing urinary or sexual concerns may feel uncomfortable even after living with the problem for many years.
Our consultations are conducted with privacy, dignity and sensitivity.
You should feel comfortable asking questions — even questions that may seem small or embarrassing.
There is no judgement.
Dr. Anand Kumar Nagwani, M.Ch. (Plastic & Cosmetic Surgery) brings a reconstructive plastic surgery perspective to complex tissue reconstruction, penile reconstruction and management of difficult surgical anatomy.
Dr. Janki Bisht Nagwani, M.Ch. (Pediatric Surgery) brings specialist pediatric surgical experience to the assessment and care of children with congenital surgical conditions.
Together, the team provides a coordinated approach to primary, complex and revision hypospadias reconstruction in children and adults.
Hypospadias can look different from child to child, and the operation should be planned accordingly.
If your child has recently been diagnosed, if you are looking for an opinion about the right surgical approach, or if a previous operation has not given the expected result, we are here to evaluate the case carefully.
A detailed consultation is the first step towards understanding the problem and planning the right reconstruction.
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