My talk at the Hypospadias International Society

1. My talk at the Hypospadias International Society (HIS)meeting I had the great privilege to take part in the HIS meeting held in Brazil a few months ago. I couldn’t go there physically due to some family commitments. So, I attended the virtual meeting for 3 days. In the meeting, I delivered a talk on 2-stage repair for complex failed hypospadias cases with the use of oral mucosal graft. I was among the very few doctors from India to attend this meeting and deliver a talk at this prestigious meeting.

2. Hypospadias is one of the most common congenital anomalies. Unfortunately, there is not much awareness in the general public or even among many doctors about this problem. There are several reasons for this: 1.Hypospadias is an external anomaly and is not usually life-threatening. So, most people think that it is a minor problem. 2.Many doctors also don’t realise thathypospadias surgery is a technically demanding operation and has to be only done by the best surgeon. 3.Most people have little awareness about the far-reaching complications of hypospadias, which not only affects urination but can potentially disrupt the normal adult life of the person and the family. 4.The social and psychological stigma associated with hypospadias. Being a genital problem, most parents are not ready to share the information with family and friends and take their help to search for the best doctor for hypospadias surgery. 5.Once the child grows older, he becomes shy and doesn’t discuss the problem with the parents anymore. 6.Most parents and many doctors think that hypospadias is a minor problem and seek a solution from the local doctors; if the surgery is successful, it is ok. But more often than not, the operation may result in failure, and only then do the parents start looking for an expert. This results in the child undergoing multiple operations, including more complex reoperations, which could have been avoided if an expert surgeon had been involved from the beginning. Thus, hypospadias remains a common and neglected problem. In addition, many surgeons of many specialities perform hypospadias surgery, and there are hundreds of techniques for hypospadias repair. This makes things more complicated for parents to choose the best surgeon and for family physicians to refer these cases to the best surgeon for hypospadias! The purpose of the Hypospadias International Society (HIS) was to disseminate proper knowledge about hypospadias correction techniques among its members. Many enthusiastic surgeons from across the globe participate in its annual meetings. The latest meeting in Brazil was attended by over 100 hypospadialogists. Various techniques of hypospadias repair, including primary and complex failed hypospadias repairs, were discussed by experts. The pros and cons of various techniques were debated by experts in a scientific atmosphere. The long-term follow- up and results of hypospadias repairs were also discussed.

3. My talk in the HIS meeting was about the most complex cases of hypospadias, which come after multiple failed operations elsewhere. These cases are very complex and require the expertise of the besthypospadias surgeon. Typically, a 2-stage (sometimes 3-stage) repair is performed utilising the skin taken from inside the oral cavity (mouth) as a graft to prepare the deficient urinary tube (urethra). We have done more than 100 such cases over the past 8 years in Hyderabad, with over 90% success of such complex operations. Our patients come from all over India, including Andhra Pradesh, Maharashtra, Karnataka, Tamil Nadu, Kerala, Orissa, West Bengal, Bihar and UP. We also performed complex redo hypospadias repairs on international patients who underwent their initial failed hypospadias operations in other countries. My talk about the technique and results of complex hypospadias reconstructions at the HIS meeting was highly appreciated. I received positive messages from many surgeons across the world congratulating us for our work and the good results. However, an ideal situation is where no child requires such complex reconstructions for failed hypospadias. This is possible if the initial hypospadias surgery is performed by experts only. When choosing the best hypospadias surgeon for their child, parents should spend some time identifying the best surgeon with the best results in hypospadias repair. Remember, even the best surgeon can have complications (like the best driver can have an accident), but the complications will be a small percentage, usually minor and easily treatable. I discussed a few tips for parents in my earlier blog about how to choose the best hypospadias surgeon for their child. That blog may be referred to by those interested in knowing more about this.