YOU'VE FOUND
THE RIGHT
HANDS.
"Every child deserves a complete life.
Every adult, a dignified one."
Hypospadias is more common than most people realise — and far more treatable than most parents fear. At Calcutta Cosmo Aid, Dr. Janki Bisht Nagwani has dedicated her surgical career to this single specialisation, bringing hope to families from across India and beyond. You are not alone in this journey, and you do not have to navigate it without expert guidance.
Hypospadias
Specialist
Restoring Form. Restoring Life.
Dr. Nagwani is a nationally recognised Hypospadias specialist. These are surgical outcomes from his personal case archive — each image shared with patient consent for educational purposes.
Sensitive surgical images shown for medical education only. All patients have given explicit written consent. Images are not intended as promotional material.
The urethral opening forms on the underside of the penis instead of at the tip. A birth condition — not caused by anything the parents did.
A BIRTH
CONDITION.
NOT A CURSE.
Common, correctable, and nothing to be ashamed of.
Hypospadias (pronounced hi-po-SPAY-dee-us) is a condition present at birth where the opening of the urethra — the tube through which urine and semen pass — is located on the underside of the penis rather than at the tip. In some cases, the penis may also curve downward (a condition called chordee).
It affects approximately 1 in every 200-300 male live births worldwide. In India alone, thousands of children are born with hypospadias every year — yet many families go years without knowing that effective surgical correction exists and is widely accessible.
The condition ranges from mild (opening just slightly below the tip) to severe (opening near the base or scrotum). With skilled surgery, the vast majority of cases are fully and permanently correctable.
हिंदी में समझें हाइपोस्पेडियास एक जन्मजात स्थिति है जिसमें मूत्रमार्ग का छेद सही जगह पर नहीं होता। यह कोई अभिशाप नहीं — एक सामान्य जन्मदोष है जिसका सफल इलाज संभव है।
A CONDITION AS OLD
AS HUMANITY ITSELF
How a birth condition known to ancient physicians became one of modern surgery's most refined specialisations — and why India stands at its forefront today.
The Greek physician Galen first described and named hypospadias — from the Greek hypo (below) and spadon (a rent or opening). The condition was recognised in antiquity, though no effective treatment existed. Families were left with no answers for centuries.
European surgeons began attempting the first hypospadias corrections in the 1800s — crude by today's standards, with high failure rates. Over 200 different surgical techniques were attempted across the century, reflecting how difficult the condition was to reliably repair.
This era belongs, in no small part, to an Indian surgeon. Dr. Hari Shankar Asopa — working at SMS Medical College, Jaipur — developed the Asopa technique, a landmark innovation in urethral reconstruction that gave surgeons a reliable method for single-stage repair in complex cases. His approach used the urethral plate as the foundation for tubularisation — a concept that was ahead of its time. His work ran parallel to, and directly influenced, the thinking of Duckett and Snodgrass. The principles Asopa established were later refined by Snodgrass into the Tubularised Incised Plate (TIP) urethroplasty — which became the global gold standard for distal repairs in the 1990s and remains so today.
An Indian contribution at the root of modern hypospadias surgery. That the world's most widely used hypospadias technique traces its lineage to a surgeon working in Jaipur is a fact too rarely acknowledged — and a source of genuine pride for Indian paediatric surgery.
Indian paediatric surgeons and urologists — trained in the UK, USA, and Australia — returned home with world-class skills. India's sheer volume of cases (due to population size) meant Indian surgeons rapidly accumulated experience that surpassed many Western counterparts. Centres of excellence emerged in Mumbai, Chennai, Delhi, and Kolkata.
Under Dr. Janki Bisht Nagwani, Calcutta Cosmo Aid has become one of Eastern India's most trusted destinations for hypospadias surgery. Over two decades, the clinic has built a reputation that draws patients not just from Bengal, but from Bihar, Jharkhand, Odisha, the Northeast — and from families abroad who want surgery performed by a surgeon they can trust, at a cost that is humane.
THE WORLD COMES
TO INDIA FOR A REASON
India has quietly become one of the world's leading destinations for hypospadias surgery. This is not a marketing claim — it is a medical reality backed by volume, training, and outcomes.
Indian surgeons operate on more hypospadias cases per year than surgeons in most Western countries — which means faster skill development, deeper pattern recognition, and better complication management. Combine this with world-class training, significantly lower costs, and English-speaking medical teams, and India becomes an obvious choice.
When parents travel from Patna, Guwahati, or even Dubai to bring their child to us — it is because they have done their research, and they trust what they have found. That trust is the most important thing we protect.
TYPES OF
HYPOSPADIAS
Not all hypospadias cases are the same. The location of the urethral opening determines the degree of severity — and the surgical approach.
The urethral opening is near the tip of the penis. Usually requires a single-stage surgery with excellent outcomes.
The opening sits on the glans (head) of the penis, just below the tip. The mildest form — often with minimal functional impact but corrected for normal urinary stream and future sexual function.
Learn MoreThe opening is at the coronal sulcus — the groove where the glans meets the shaft. Still considered mild, but surgical correction ensures a properly directed urinary stream and prevents long-term complications.
Learn MoreOpening is along the shaft of the penis. May involve chordee (curvature). Often requires one to two stages depending on severity and tissue availability.
Just below the corona, on the upper shaft. Mild-moderate in impact; typically correctable in a single procedure.
Learn MoreOpening on the distal (upper) portion of the shaft. One of the most common forms encountered surgically. TIP urethroplasty is the preferred technique.
Learn MoreOpening at the midpoint of the shaft. Often associated with chordee. May need staged repair depending on the degree of curvature and tissue quality.
Learn MoreNear the base of the shaft. Significant chordee is common. Staged repair is frequently needed. Requires careful pre-operative planning and experienced hands.
Learn MoreOpening is at or near the scrotum or perineum. Almost always requires multiple staged surgeries. This is where specialist experience matters most.
Opening at the junction of the penis and scrotum. Severe chordee is typical. Staged surgery over 6–12 months is standard. Outcomes are excellent in experienced hands.
Learn MoreOpening within the scrotum itself. May be accompanied by bifid scrotum or undescended testes. Complex multi-stage reconstruction required. Hormonal preparation may be needed before surgery in children.
Learn MoreThe most severe form — opening at the perineum (behind the scrotum). Requires extensive staged reconstruction, often 3 or more procedures. A disorder of sexual development (DSD) workup is essential before planning surgery.
Learn MoreA clinical assessment is the only way to know for certain. Many families come to us with a diagnosis from another doctor — sometimes correct, sometimes not. Dr. Janki personally evaluates every patient before any surgical plan is made. No two cases are identical.
WHY SURGERY
MATTERS.
Many families ask: "He seems fine — do we really need to operate?" It is a fair question, and it deserves an honest answer.
In many cases of hypospadias, the urinary stream is directed downward, sideways, or scattered — making it impossible to urinate standing up. This is not a minor inconvenience. It affects hygiene, dignity, and daily life. In severe cases, the abnormal stream can lead to urinary tract infections, difficulty emptying the bladder, and long-term kidney-related complications if left uncorrected.
In moderate to severe hypospadias, chordee (penile curvature) makes sexual intercourse painful or impossible. The displaced urethral opening can also affect the direction of semen, impacting fertility. These are correctable problems — but only if surgery is performed at the right time, by the right surgeon. Leaving them unaddressed does not make them disappear.
Children notice. Adolescents especially so. Boys with uncorrected hypospadias frequently experience shame, anxiety, and social withdrawal — particularly in school environments. Studies consistently show that early surgical correction, before school age, results in significantly better psychological outcomes. A child who grows up with a corrected anatomy grows up without that burden.
A significant number of Dr. Nagwani's patients are adults — men in their 20s, 30s, and 40s who were never treated as children, or whose earlier surgeries failed. Age is not a disqualifier but also not the only criteria. Adult repairs are more complex, and may require staged procedures, but the outcomes remain excellent in experienced hands. The first step is always a proper assessment.
SURGERY HAPPEN?
THE COST OF
WAITING TOO LONG
Hypospadias does not resolve on its own. With time, the challenges compound. What is a straightforward single-stage surgery in infancy can become a multi-stage reconstruction in adulthood — more complex, more expensive, and with a longer recovery. The body changes. Scar tissue forms. Tissue availability decreases.
We say this not to frighten — but to inform. Early action is always the kinder choice.
Dr. Janki Bisht Nagwani has spent her entire surgical career on hypospadias. Every case she takes on is evaluated personally, planned carefully, and operated by her own hands. No delegation. No shortcuts. Your child's outcome is her personal responsibility.
Book Your ConsultationWe understand that the decision to operate on your child — or yourself — is not taken lightly. You may have questions, fears, or a previous experience that makes you hesitant. That is perfectly normal. Call us, message us, or simply walk in. There is no pressure. There is only information, and care.
+91 62894 76932THE
PROCEDURE
EXPLAINED.
"Understanding what will happen — step by step — is the first thing that calms a parent's mind. We walk every family through this before we ever enter the operating room."
A thorough clinical assessment is conducted by Dr. Janki — examining the type, degree, and associated features (chordee, skin quality, tissue availability). For children, hormonal preparation with testosterone cream may be prescribed for 4–6 weeks prior to surgery to increase tissue size and improve surgical outcomes. Blood tests and anaesthesia fitness are confirmed. The family is fully briefed on what to expect.
Surgery is performed under general anaesthesia — the child or patient is completely asleep and feels nothing. A caudal block (a type of regional anaesthesia injected near the tailbone) is also administered in children to minimise post-operative pain. The procedure typically takes 1 to 3 hours depending on the complexity of the case.
The core goals of the surgery are: (1) correct the chordee (straighten the penis), (2) reconstruct the urethra to reach the tip, and (3) achieve a cosmetically normal appearance. The technique used depends on the type and degree of hypospadias — Dr. Janki selects the most appropriate approach for each individual case. Sutures used are absorbable (self-dissolving) — no painful stitch removal is needed.
A urinary catheter (a thin tube) is left in place for 7 to 14 days to allow the reconstructed urethra to heal undisturbed. This is normal and expected — not a sign of complication. Most children are discharged within 24 hours after catheter removal. Parents are given detailed written instructions on wound care, catheter management, and what signs to watch for. Pain is usually well-controlled with standard medication.
The first review is at catheter removal (day 7–14). A second review follows at 4–6 weeks to assess healing. For staged repairs, the next surgical stage is planned 6 months after the first. Dr. Janki personally conducts all follow-up reviews — the same surgeon who operated is the same surgeon who monitors your recovery. Patients from outside Kolkata can send photographs via WhatsApp for remote assessment between visits.
Tubularised Incised Plate — the global gold standard for distal repairs. Uses the patient's own urethral plate tissue. Excellent cosmetic and functional outcomes in a single stage.
Meatal Advancement & Glanuloplasty — a reliable single-stage technique for the mildest forms. Minimal tissue disruption, rapid healing, excellent results.
Two-stage approach using buccal mucosa (inner cheek tissue) or preputial skin grafts. Reserved for complex or re-do cases. Stage 1 grafts tissue; Stage 2 (6 months later) reconstructs the urethra.
WHY MORE
THAN ONE
SURGERY REQUIRED FOR SOME?
"The surgeon said my child needs two operations. Does that mean something went wrong?"
No. In many hypospadias cases — especially moderate to severe ones — staged surgery is not a complication. It is the plan. It reflects careful, deliberate surgical strategy, not failure. Understanding why staging is sometimes necessary helps families approach the journey with confidence rather than fear.
Reconstructing a urethra requires healthy, pliable tissue. In severe cases, there simply isn't enough local tissue to complete the full repair in one sitting. The first stage grafts new tissue (often from the inner cheek or foreskin) and allows it to integrate and mature. The second stage, 6 months later, uses this now-established tissue to build the new urethra.
In cases with significant penile curvature (chordee), the curve must be fully corrected before the urethra can be reconstructed. Attempting both simultaneously in a severely curved penis risks poor healing and high complication rates. Separating the two steps allows each to be done properly and safely.
Tissue grafts need 4–6 months to establish their blood supply and integrate fully before they can be used surgically. This wait is not wasted time — it is essential time. Rushing the second stage before the graft has matured significantly increases the risk of fistula (an abnormal opening) and repair breakdown.
The curvature is corrected. A tissue graft (buccal mucosa from the inner cheek, or preputial skin) is placed on the underside of the penis and secured. A catheter is placed for 10–14 days. The child goes home within 24 hours and recovers normally while the graft integrates.
The grafted tissue establishes its blood supply and softens into the surrounding skin. Regular follow-up — including WhatsApp photo reviews for outstation patients — confirms graft health. No rush. Biology cannot be hurried.
The matured graft is now tubularised to form the new urethra, which is extended to the tip of the penis. Cosmetic refinements are completed. Another catheter period of 10–14 days follows. Most patients achieve a fully functional, normal-appearing result after this stage.
Total journey: approximately 8–10 months from first surgery to full recovery. For mild to moderate cases that only need a single stage, the entire process — including recovery — is typically complete within 6–8 weeks.
RE-DO SURGERY:
A SECOND CHANCE
A significant portion of Dr. Janki's patients come to her after a failed repair performed elsewhere — whether at a general hospital, by an inexperienced surgeon, or abroad. These are among the most complex cases in hypospadias surgery.
Scar tissue from previous surgeries reduces tissue availability. Anatomy is distorted. The risk of complications is higher. And yet — with the right expertise, re-do surgeries succeed. Dr. Janki has extensive experience in salvage hypospadias repairs. If your child has been through surgery before and the result is unsatisfactory, do not give up. Come and be assessed.
A small hole forms between the new urethra and the skin surface, causing urine to leak. One of the most common post-op complications — fully correctable with re-do surgery after adequate healing time.
Narrowing of the reconstructed urethra causes a weak or split stream. Requires careful re-evaluation and surgical correction, sometimes with additional grafting.
Curvature that was not fully corrected in the initial repair. Causes discomfort and functional difficulty. Correctable — but requires careful dissection of previous scar tissue.
The functional result is adequate but the appearance causes psychological distress. Revision surgery to improve the cosmetic outcome is a legitimate and valid reason to seek further care.
"Every parent we meet is worried. That is normal. What we tell them is this: you are not alone in this, you have found the right team, and we will walk every step of this journey with you — from the first consultation to the final review. One surgery or three, we are here." — Dr. Janki Bisht Nagwani, Calcutta Cosmo Aid
WHAT TO EXPECT
& WHEN
A realistic, phase-by-phase guide to recovery — so you are never left wondering whether what you are seeing is normal.
The child is discharged within 24 hours after catheter removal. A urinary catheter drains urine continuously — this is completely expected and essential for the new urethra to heal without pressure. Some swelling, bruising, and discomfort around the surgical site is normal. Pain is well managed with standard oral medication.
The catheter is removed at day 7–14 during the first follow-up visit. The first few urinations may feel different — the stream may be slow, split, or slightly off-angle as the new urethra adjusts. This usually improves within days to weeks. Swelling continues to reduce. Activity restrictions are gradually lifted.
The surgical site continues to mature. Scar tissue softens and the skin takes on a more natural appearance. The urinary stream should be straight, strong, and forward-directed by this stage. For staged repairs, this is the waiting period before the second surgery — follow-up photographs via WhatsApp allow Dr. Janki to monitor graft health remotely.
By 6–12 months post-surgery, the final result is fully evident. A successful repair means a child who urinates standing, with a straight stream from the tip — and an appearance that is cosmetically indistinguishable from normal. For staged repairs, this milestone is reached after the second surgery completes the reconstruction. Long-term follow-up into puberty is recommended to monitor growth-related changes.
WHAT A GOOD
RESULT LOOKS LIKE
Success in hypospadias surgery is not just functional — it is also psychological. A child who grows up able to use a urinal like any other boy, without shame or difficulty, is the true measure of a successful repair.
We aim for three things in every case: a urethral opening at the tip, a straight penis, and a cosmetically normal appearance. When all three are achieved, the surgery is a success — and the patient can move forward with their life.
Most recoveries are smooth and uneventful. But knowing what to watch for — and acting quickly when you spot it — makes a significant difference in outcomes. When in doubt, send us a WhatsApp message with a photograph. We respond promptly.
May indicate infection. Contact us within the day — do not wait.
A urinary fistula — not an emergency, but needs prompt assessment and follow-up planning.
After catheter removal, inability to pass urine needs same-day review.
Worsening stream weeks after surgery may indicate stricture — schedule a review.
Minimal spotting is normal. Active bleeding or soaked dressings — contact us immediately.
You are never being dramatic. Send us a WhatsApp photo and we will tell you if it needs attention.
COMPLICATIONS:
WHAT CAN
GO WRONG.
"We believe that an informed patient — and an informed parent — is a safer patient."
No surgery is without risk. Hypospadias repair, even in the most experienced hands, carries a defined set of possible complications. We do not hide this. What separates a specialist centre from a general one is not the absence of complications — it is the experience to recognise them early, manage them well, and prevent them wherever possible. Here is what you need to know.
These are well-known, expected possibilities in hypospadias surgery — not rare surprises. Each is manageable.
A small abnormal opening forms between the new urethra and the skin surface, causing urine to leak from a point other than the tip. Occurs in 5–15% of distal repairs and higher in proximal or re-do cases. It is not a surgical failure — it is a known biological possibility when tissue heals under tension or with inadequate blood supply.
Narrowing of the reconstructed urethra causes a progressively weak or difficult stream. Usually caused by scar tissue forming at the anastomosis (join) or along the neourethra. More common in longer reconstructions and re-do surgeries.
Some degree of curvature persists after surgery — either because the initial correction was incomplete, or because growth during puberty pulls the penis into a curved position as scar tissue does not stretch with the rest of the anatomy. Mild residual chordee may be acceptable; significant curvature requires revision.
The urethral opening migrates slightly downward from the tip as healing progresses — a result of scar contraction. In mild cases, this is cosmetically and functionally acceptable. In significant regression, the stream is redirected and revision is warranted.
These occur infrequently — but patients deserve to know they exist.
Rare with prophylactic antibiotics. Treated promptly with antibiotics and wound care. Very rarely affects the final surgical outcome.
The tissue graft fails to integrate — most often due to infection or shear. Requires re-grafting after a waiting period. Uncommon with proper post-op care.
A pouch forms in the reconstructed urethra, causing pooling of urine. Correctable with a targeted revision procedure.
All anaesthesia carries a small general risk. Our anaesthetic team follows paediatric protocols specifically designed for infant and child safety.
Blood pooling under the skin at the surgical site. Usually resolves on its own. Rarely requires return to theatre for evacuation.
Loss of a small area of skin due to inadequate blood supply. Extremely rare. Managed conservatively or with minor revision once healed.
HOW WE KEEP
COMPLICATIONS LOW
Complication rates in hypospadias surgery are directly tied to surgeon experience, case volume, and technique selection. A surgeon who performs 20 hypospadias repairs a year is statistically more likely to encounter complications than one who performs 200. Experience builds pattern recognition. It builds hand memory. It builds the ability to recognise when something is wrong before it becomes a problem.
At Calcutta Cosmo Aid, Dr. Janki personally operates on every case. There is no delegation to a junior registrar. No handoffs. The same surgeon who plans the repair performs it — and reviews it at every follow-up.
Contact us immediately by WhatsApp with a photograph of the area of concern. Dr. Janki reviews all post-operative messages personally. Most complications are manageable, correctable, and far less serious than they appear to a worried parent. You are not alone in this.
QUESTIONS
FAMILIES
ALWAYS ASK
These are the questions we hear most often — from parents at their first consultation, from adults who have carried this condition for decades, and from families who have been through surgery elsewhere and are unsure what to do next.
That said, surgery can be performed at any age. Children who missed this window, adolescents, and adults can all be successfully treated. The complexity may be higher and staged repair more likely — but the outcome goal remains the same. Do not let age alone discourage you from seeking assessment.
Post-operatively, mild to moderate discomfort is expected for 3–5 days, well managed with standard oral paediatric pain medication (paracetamol and ibuprofen). Most children are surprisingly comfortable within 24–48 hours of discharge. Parents often worry more than the child does.
The catheter is removed at your first follow-up appointment. The removal itself takes only a few seconds and causes brief, mild discomfort. Children adapt remarkably quickly to the catheter — and most parents find managing it at home far easier than they expected.
Re-do (salvage) hypospadias surgery is more complex than primary repair. Scar tissue limits options. Tissue availability is reduced. But with careful assessment and the right surgical strategy, the outcome can be dramatically improved. We do not turn away complex cases. We assess them honestly and plan realistically.
We believe in complete transparency — you will receive a full, written cost estimate before any decision is made. There are no hidden charges. We also do our best to accommodate families travelling from other states who need help with planning. Please WhatsApp or call us for a personalised estimate after your initial consultation.
Two in-person visits are essential: the surgery itself, and catheter removal at day 7–14. After that, most follow-up is managed via WhatsApp photograph reviews — you send us photos of the healing area and Dr. Janki assesses remotely. If something needs in-person attention, we will tell you clearly and you come back. We plan the entire schedule in advance so you can book travel accordingly. Distance has never stopped us from looking after our patients properly.
In uncorrected or poorly corrected cases, chordee can make intercourse difficult or painful, and semen misdirection can affect fertility. This is why timely, expert surgery matters. Your child deserves the same future as any other child.
Many adult men who come to us have lived for decades with shame, functional difficulty, or relationship impact — and have never sought help because they assumed it was too late, or that no one could help. We can. Come for an assessment. Let us tell you what is possible.
Hypospadias is not caused by anything the parents did. It is a developmental variation during foetal genital formation, and the precise cause in any individual case is usually unknown. Screening the genitalia of newborn male siblings is recommended if there is a family history.
THE FIRST STEP
IS THE HARDEST.
WE MAKE IT EASY.
A single message or phone call is all it takes. Dr. Janki's team will guide you from there.
Thank you. Dr. Janki's team will contact you within 24 hours to confirm your consultation. If you need a faster response, please WhatsApp us directly on +91 70442 34868.
"Whatever stage you are at — newly diagnosed, long uncertain, or returning after a failed surgery — you will be heard, assessed honestly, and cared for with the full attention of a specialist who has dedicated her career to exactly this."