Hypospadias is a birth defect in baby boy in which the penis neither works well nor looks normal. It is the defect of the Urethra in the male where the urinary opening (Meatus) is not at the usual location on the head of the penis instead that is on the underside of the penis or below the penis associated with curvature (in few cases) and disfigured skin.



It is diagnosed on the basis of a physical examination done by a urologist. It is one of the most common birth abnormality in boys, affecting approximately 1 of every 250 new born boys.



The exact cause of hypospadias is unknown.  There are many factors believed to be involved in its development. Genetics, the environment and hormones may be factors that influence the development of this structural difference. Sometimes hypospadias is genetic.


  • Opening of the urethra at a location other than the tip of the penis
  • Abnormal splaying during urination
  • Downward curve of the penis (chordee) A condition called chordee is often seen with Hypospadias. Chordee is a downward curve of the penis. The foreskin is often not completely formed on its underside. This result in a “dorsal hood” that leaves the tip of the penis exposed.
  • Hooded appearance of the penis as only the top half of the penis is covered by foreskin




  • Distal or Glanular:  most common form when opening is found near the head of the penis
  • Midshaft:  when opening is found in the middle to the lower shaft of the penis
  • Penoscrotal:  when  opening is found where the penis and scrotum join
  • Perineal: when opening is behind the scrotal sac. These are the most severe forms of hypospadias and are less frequently found.





There are more chances of failure if males with Hypospadias are operated by a routine Urologist. Adults / Children with complications following childhood hypospadias repair can still be re-operated with good success rate if are operated by a reconstructive urologist who has been performing routinely.



Adult hypospadias are those Males diagnosed with Hypospadias but has not got it corrected at childhood; they live with hypospadias all their life. Such Men suffer needlessly with a regret that they went through their life ignorant to options.  This is absolutely treatable disorder. They can have a normal appearing and functioning penis. They can pee normally and not spray all over the place. They can have pain free sex.


The goal of any type of hypospadias surgery is to make a normal, straight penis with a urinary channel that ends at or near the tip. The operation mostly involves 4 steps:

  • straightening the shaft
  • making the urinary channel
  • positioning the meatus in the head of the penis
  • circumcising or reconstructing the foreskin

Hypospadias repair is often done in a 90-minute (for distal) to 3-hour (for proximal) same-day surgery. In some cases the repair is done in stages. These are often proximal cases with severe chordee. The Reconstructive Urologist often wants to straighten the penis before making the urinary channel.

Hypospadias can be fixed in children of any age and even in adults.

A successful repair should last a lifetime. It will also be able to adjust as the penis grows at puberty.

“Surgical correction can be undertaken in early childhood or in later life by a reconstructive urologist”.



HYPOSPADIAS IF UNTREATED influences a man’s psycho-social status. Affected man often feels like he has got this horrible secret in his pants and if others will find out, they would make fun of him.  Hypospadias leads to shame, aloneness and depression that a guy can feel when he is growing up. One of the reasons for feeling so different is because he needs to sit down to pee unlike other Males.

Parents usually ask the Urologist that their child urinates comfortably and has bowel movements just fine. So why are we having the surgery done if it doesn’t hurt him and he urinates just fine? Simple answer to these parents is Surgery is essential because Hypospadias can cause following problems as he gets older:

1. Irregular urine stream .He would have to pee sitting down his whole life.

2. His penis would look different than other boys.

3. It could potentially create fertility issues. The opening of the penis is not close to the cervix as a result of which the sperm is not in the right place to cause pregnancy.

4. If the penis has chordee (downward curvature of the penis) it becomes very painful, difficult or even impossible to have intercourse as an adult.


The complication rate in boys with distal hypospadias repair is less than 1 in 10. Problems happen more often after a proximal correction.

The most common problem after surgery is a hole (“fistula”) forming in another place on the penis. This is from a new path forming from the urethra to the skin. Scars can also form in the channel or the urethral opening. These scars can interfere with passing urine. If your child complains of urine leaking from a second hole or a slow urinary stream after hypospadias repair, he should see his pediatric urologist.

Most complications appear within the first few months after surgery. But fistulas or blocks might not be found for many years. Most problems are easily fixed with surgery after the tissues have healed from the first operation (often at least 6 months).



Recovery time is bit longer in patients following Re-do surgery for failed hypospadias repair with respect to the Hypospadias surgery done initially. The patient after Re-do surgery can start peeing normally after 2-3 weeks. It may take 3 months for the penile skin to be healed fully. Urinary catheter is kept for 10-20 days post surgery.



Yes definitely the patient can have a normal penis provided the surgery is done by a Urologist specialized in Hypospadias Repair. You need to follow the instructions given by the surgeon strictly. Do visit for a follow up after the procedure.



Usually it takes 3-4 hours to operate such cases but it differs from case to case depending upon the complexity of the disease. In few cases need multiple stages 6-8 months apart.


Modern anaesthetic techniques, fine instrumentation, sutures, dressing materials, and antibiotics have improved clinical outcomes and have, in most cases, allowed surgical treatment with a single-stage repair within the first year of life on an outpatient basis.

Success Rate at Centre of Urethra and Penile Surgery is 95%.



  • At our centre for Urethra and Penile surgery the success rate is high as we use latest techniques to operate. We encourage such patients to get themselves reviewed atleast once in a year.
  • Gautam Banga has successfully operated more than 800 Hypospadias cases in his one decade of experience.
  • High success rate in primary cases
  • Achieved success in failed cases of Hypospadias
  • Gautam Banga is invited by his fellow Urologists as a core-specialty expert in Genito-Urinary reconstruction in various parts of Delhi-NCR.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316
Email:- info@urethraandpenilesurgery.com


Failed Urethroplasty Treatment In India

Failed Urethroplasty

Failed Urethroplasty treatment by one of the best Reconstructive Urologists. Urethra is one of the most vital parts of the body, thatregulates the excretion of urine from the body. In men, urethra also forms the passage for the ejaculation of sperms. However, this thin, fibro-muscular tube could also be easily ruptured, causing severe pain. In most of the cases, urethroplasty serves as the best course of action if there is any injury or defect inside the urethra.

Failed Urethroplasty

What is failed urethroplasty

Failed Urethroplasty is a surgical procedure to treat any rupture inside the walls of urethra. These ruptures could be caused due to trauma, infections or physical injuries. Urethroplasty is considered to be the go-to medical procedure, since the success rate in urethroplasty is quite high.

During urethroplasty, the urethra is reconstructed via surgical procedure and using a urethral catheter. This catheter is left inside the urethra for few weeks, during which time urethra is completely healed.


Types of urethroplasty

Based upon multiple factors (like the physical condition of patient, severity of defect, status of urethra etc.) there are generally 4 types of urethroplasty:


1) Anastomotic urethroplasty

This is a single-stage surgery, where the urethra is envisioned (in the range of the deformity), and the cut is made at its mid-line (as a rule), utilizing a bovie blade to dissect both the dermal as well as sub-dermal layers until the related musculature, corpus cavernosum, ventral urethral perspectives and corpus spongiosum are uncovered. Specific care is provided amidst the procedure to avoid any harm to nerves and veins (which could become a cause of erectile dysfunction or loss of penile sensitivity).

This technique is quite successful, with a rate of success over 95%. Anastomotic urethroplasty is viewed as the “best quality level” of surgical repair alternatives, since it is comparatively easier with high success rate.

2) Buccal mucosal onlay graft

In this technique, the range of the defect is assessed and marked horizontally mid-line, and the sutures are situated (one, each) at the proximal and distal closures of the zone of urethra nearest to fringe of the blemished territory. At the same time, a urological specialist who is expert in buccal mucosal gathering systems will start to collect and repair a segment within cheek of the patient, relative to the measurement/shape ascertained and asked for by the specialist performing the urethral part of the methodology.

With a high success rate of 87-98%, buccal mucosal onlay urethroplasty is viewed as the best of repair alternatives for strictures larger than 2 cm long.

3) Scrotal/penile island graft

This type of surgery is carried out in male patients. A scrotal graft (or, in some cases, a penile island flap) is sutured in the location, fixed with firbin glue to prevent any leakages. The whole process is carried out using micro surgical techniques. Due to high complexity, this type of urethroplasty has a success rate of 70-85%, thus making is not an attractive choice. However, in cases of strictures larger than 4cm, it could be opted for.

4) Johansen’s urethroplasty

This complex urethroplasty involves opening the urethra ventrally, while a skin strip (usually created from scrotum) is buried inside for the repair. Due to its high complexity, only a few cases have ever opted for this, thereby making no data for success rate available.
Failed urethroplasty

Even though urethroplasty is the benchmark for any treatment of urethra, it is not completely successful. Severe complications might occur in up to 12% of the cases, while minor ones might be as high as 40%. Let’ take a look at some of the causes of failed urethroplasty:


  • The major cause for failure in case of anastomotic urethroplasty was the inadequate excision of the wound at the top of prostatic urethra. Surgery in case of scars around the urethra often leads to failures. Other causesincludeischemia and tension hematoma. In general, defects that have existed for a longer time have higher chances of having a failed urethroplasty.
  • In case of buccal mucosal onlay graft, the success rate is generally better. The main causes include formation of proximal anastomotic ring or distal anastomotic ring, or the loss of entire graft. In presence of these factors, BMG urethroplasty is generally discouraged. However, in other cases, it gives excellent results.
  • The length of strictures directly affects the success of any urethroplasty. In almost every case, stricture with greater length at a higher risk factor associated with them.
  • As opposed to popular notion, the size of defect has almost no impact upon the success of the surgery. Likewise, the patients’history of previous urethroplasty has no importantinfluence on the outcome of the current operation.

Statistically, the chances of the urethroplasty getting failed are quite low. In case of BMG urethroplasty, for example, there is less than 3% chance that any significant complication would arise. However, no matter how small, the chances of a failed urethroplasty always persists. The complications that arise are generally minor ones. Some of such post-surgical complications are:


  • The stricture may not be completely eliminated, and might return after surgery.
  • The patient might suffer from urinary incontinence, which is the involuntary leakage of urine. This complication is more common in women.
  • The patient could suffer from erectile dysfunction. In most cases, this is a temporary post-surgery symptom, but sometime it could become a severe condition in itself.
  • Urinary retention is also a common complication, where the patient might not be able to completely empty the bladder even after many attempts. Due to this, the patient might get the urge to urinate frequently.
  • Retrograde ejaculation is a less common, but more severe complication. In this case, the patient is unable to ejaculate the semen via urethra, which instead gets deposited in the urinary bladder. This is not a symptom and must be treated immediately.
  • Bleeding from both external and internal sature lines.



Urethroplasty is one of the most popular courses of actions in case of ruptured or infected urethra. Countless patients, with their success stories, have popularized this surgery among people and doctors alike. However, failed urethroplasty is not unheard of, and the factors that contribute to them must be kept in mind. Patients must be aware of the complications that might arise in case of urethroplasty procedure those are not successful, and what must be done in that case.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316
Email:- info@urethraandpenilesurgery.com