Primary Hypospadias Surgery

Paediatric & Adult Urethroplasty

Primary hypospadias repair is a delicate reconstructive surgery aimed at repositioning the urethral opening to the tip of the glans and straightening the penile shaft (chordee correction). Dr. Anand Kumar Nagwani specializes in one-stage and two-stage urethroplasties tailored to the severity of the defect.

Hypospadias can be a relatively simple condition in one child and a complex reconstructive problem in another.

At the Hypospadias Specialty Center, we evaluate children from 3 years onward, adolescents and adults requiring primary hypospadias reconstruction.

Our goal is to understand the individual anatomy first and then select a reconstructive technique that addresses the important elements of the condition — the urinary opening, penile curvature, urethral tissues, glans and skin coverage.

Paediatric Cases

Careful Planning for Growing Children

For parents, the decision to proceed with surgery can naturally bring many questions.

Our consultation focuses on understanding the child's anatomy and explaining:

• Where the urinary opening is located
• Whether penile curvature is present
• How developed the urethral plate is
• Whether the glans and skin are suitable for reconstruction
• Whether one or two stages may be required
• What recovery may involve
• What complications should be understood beforehand

At our centre, primary surgery is undertaken from 3 years of age onward according to our centre's treatment protocol.

Distal Hypospadias

Distal cases generally have the urinary opening closer to the head of the penis.

When the anatomy is favourable, a single-stage urethroplasty may be possible.

Depending on the individual case, techniques such as TIP urethroplasty may be considered.

The operation is selected after examining the urethral plate, glans, meatus and curvature.

Midshaft Hypospadias

Midshaft hypospadias lies between the distal and proximal forms.

The surgical complexity can vary significantly.

Some children have a good urethral plate with little curvature, while others may have more significant chordee or tissue deficiency.

Treatment may involve:

Urethral reconstruction + chordee correction + appropriate skin coverage

A single-stage or staged procedure may be selected depending on the anatomy.

Proximal Hypospadias

More Complex Anatomy Needs More Detailed Planning

Proximal hypospadias can involve significant curvature and more extensive urethral deficiency.

In these cases, the surgeon may need to carefully assess whether the existing urethral plate can be used for reconstruction.

Depending on the findings, treatment may involve:

• Chordee correction
• Urethral plate preservation or reconstruction
• Single-stage urethroplasty
• Two-stage reconstruction
• Graft-based reconstruction in selected cases

The decision is made individually rather than based only on the location of the urinary opening.

Early Intervention Protocols

At our centre, primary hypospadias reconstruction is undertaken from 3 years onward.

We understand that many parents may have read different recommendations about the ideal age for surgery. International recommendations often favour repair during infancy, whereas our centre follows a 3+ years surgical protocol.

During consultation, we explain the reasoning behind the planned timing for the individual child rather than applying the same approach to everyone.

Chordee Correction

Straightening the Penis Is Part of the Repair

If curvature is present, it is assessed as an important part of the reconstruction.

The correction required depends upon the severity and underlying cause of the curvature.

The surgical objective is to achieve a functionally straight penis, while maintaining healthy tissues and allowing appropriate urethral reconstruction.

Single-Stage & Two-Stage Repairs

Choosing the Right Pathway

Single-Stage Repair

When the anatomy is suitable, the necessary reconstruction may be completed in one operation.

Two-Stage Repair

In selected complex cases, reconstruction may be divided into two planned stages.

The first stage prepares the tissues and corrects the underlying anatomical problems. After healing and maturation, the second stage completes the urethral reconstruction.

A staged approach may be particularly useful when the urethral plate or local tissues are unsuitable for a reliable single-stage reconstruction.

Adult Primary Hypospadias

Treatment Can Still Be Considered in Adulthood

Not every man with hypospadias was treated during childhood.

Some men have lived with the condition for many years and seek treatment only when urinary, functional, sexual or personal concerns become more important.

Adult assessment may include evaluation of:

• Urinary flow
• Meatal position
• Penile curvature
• Urethral condition
• Scar tissue
• Previous procedures
• Sexual function
• Individual treatment goals

Adult reconstruction is planned according to the anatomy that is present today.

What We Aim For

Every reconstruction has individual limitations, but our surgical planning focuses on:

A functional urinary passage

Appropriate correction of penile curvature

Healthy tissue coverage

Durable reconstruction

Long-term consideration of growth and adult function

The goal is not simply to make the penis look different after surgery. The goal is meaningful functional reconstruction.

For Parents

You Do Not Have to Figure Everything Out Alone

If your child has been diagnosed with hypospadias, it is completely natural to have questions.

You may be wondering:

Does my child need surgery?

How serious is the condition?

Is there curvature?

Will one operation be enough?

What happens if a complication occurs?

Should we wait or proceed?

These are exactly the questions that should be discussed during a proper consultation.

Bring your concerns openly. We believe parents should understand the condition and the proposed treatment before making an informed decision.

For Adults

A Long-Standing Condition Still Deserves Attention

Whether you were never treated or have concerns after childhood surgery, you can seek an evaluation at any age.

There is no need to feel uncomfortable discussing a condition you have lived with for years.

A private consultation can help determine whether treatment is appropriate and what reconstructive options may be available.

Explore Our Case Categories

Paediatric & Adult Primary Cases

Distal, midshaft and proximal hypospadias reconstruction.

Chordee Correction

Assessment and correction of penile curvature as part of reconstruction.

Single & Two-Stage Repairs

Individualized reconstruction based on anatomy and tissue quality.

Adult Cases

Primary reconstruction and assessment of long-standing hypospadias.

Complex Anatomy

Careful planning for more extensive proximal or tissue-deficient cases.