Hypospadias and Epispadias Surgery

Hypospadias and epispadias are conditions that affect the normal development of the urethra in children. Both are present from birth and, in most cases, require surgical correction to ensure normal urinary function, healthy development, and long-term quality of life.

At Nephro Uro Clinic in Bengaluru, Dr. I. R. Ravish performs hypospadias and epispadias surgery in Bengaluru with over 20 years of dedicated urology experience. Each child’s treatment plan is built around their specific anatomy, severity, and age, with the goal of achieving the best possible functional and cosmetic outcome.

Hypospadias and Epispadias Surgery

What is Hypospadias?

Hypospadias is a condition where the opening of the urethra, the tube through which urine passes out of the body, is not at the tip of the penis as it should be. Instead, it forms somewhere along the underside of the penis, the shaft, or near the scrotum, depending on severity.

It is one of the most common congenital conditions in boys, affecting approximately 1 in every 200 to 300 male births. In most cases, hypospadias is identified at birth during a routine newborn examination.

Without surgical correction, hypospadias can cause difficulty with urination in a standing position, an abnormal urine stream, and, later in life, difficulties with sexual function.

What is Epispadias?

Epispadias is a rarer condition where the urethral opening forms on the upper surface of the penis rather than at the tip. It occurs in approximately 1 in 100,000 male births and is less common in females.

Epispadias ranges from mild forms where only the urethral opening is affected, to more complex forms where the bladder neck and urinary control mechanism are involved. Severe epispadias is often associated with a condition called bladder exstrophy, where the bladder is exposed on the outside of the abdomen.

Because of this range, epispadias surgery in Bangalore requires careful assessment of each case before a treatment plan is recommended.

Types of Hypospadias

Hypospadias is classified by the location of the urethral opening.

Distal hypospadias is the most common type. The opening is near the head of the penis (glans). Urinary function is usually close to normal and surgical repair is typically straightforward, often completed in a single operation.

Midshaft hypospadias places the opening along the middle of the penile shaft. There may be some downward curvature of the penis (chordee) that also needs to be corrected at the time of surgery.

Proximal hypospadias is the most severe form. The opening is near the base of the penis, scrotum, or perineum. Significant curvature is common and a staged surgical approach may be needed, meaning two separate operations done several months apart.

Types of Epispadias

Penile epispadias involves the urethral opening on the upper surface of the penile shaft. Urinary control is usually maintained.

Penopubic epispadias is the most severe form in males, where the opening is at the base of the penis near the pubic bone. Urinary incontinence is common because the sphincter mechanism that controls urine flow is often incomplete.

In females, epispadias is rare and presents as a bifid clitoris with the urethral opening above the clitoris. Urinary leakage is a common feature.

Causes and Risk Factors

The exact cause of hypospadias and epispadias is not always identifiable. Development of the urethra happens during the first trimester of pregnancy and can be affected by several factors.

Known risk factors include:

  • A family history of hypospadias or epispadias in a parent or sibling
  • Hormonal influences during early pregnancy, including low androgen levels during fetal development
  • Certain medications taken during pregnancy, including some hormone-based treatments
  • Environmental factors, though research in this area is ongoing
  • Advanced maternal age and low birth weight have been associated with higher incidence in some studies

Most cases occur without any identifiable cause or family history.

When Should Hypospadias Surgery Be Done?

Timing of surgery is one of the most important decisions in hypospadias management. According to published guidance and the American Academy of Pediatrics, the most suitable age for hypospadias repair is between 6 and 18 months.At this stage, penile tissues are soft and highly elastic, which allows precise reconstruction, and healing capacity is at its peak, leading to minimal scarring.

Operating in this age window also means the repair is complete before toilet training begins, and the child has no psychological memory of the procedure.

If the optimal window is missed, another opportunity for surgery is at 3 to 4 years of age. Hypospadias can also be corrected in older children and adults, though the tissue is less pliable and outcomes may require more complex planning.

For epispadias, the timing depends on severity. Mild cases may be repaired in the same age window as hypospadias. Complex penopubic epispadias with bladder involvement is typically managed in stages, beginning in the first year of life.

Symptoms to Watch For

Most cases of hypospadias and epispadias are identified at birth. Parents and doctors should look for:

In hypospadias:

  • The urethral opening is visibly not at the tip of the penis
  • The foreskin may appear hooded or incomplete on the underside
  • A downward curve of the penis (chordee), which becomes more visible with erection
  • Urine that sprays sideways or downward rather than in a straight stream
  • The child cannot urinate standing up in a normal way

In epispadias:

  • The urethral opening is on the top surface of the penis
  • Urinary leakage or difficulty controlling urine, particularly in penopubic forms
  • A wider than normal pubic area in severe cases
  • In females, a bifid or split clitoris with urinary incontinence

If any of these features are noticed, an early consultation with a paediatric urologist is advised. Early referral allows proper planning and ensures surgery takes place within the recommended age window.

How is Hypospadias Surgery Performed?

The goal of hypospadias repair is to create a urethra that opens at the tip of the penis, correct any curvature, and achieve a natural appearance. The procedure used depends on the type and severity.

Tubularized Incised Plate (TIP) repair, also called the Snodgrass technique, is the most widely used method for distal and some midshaft hypospadias. It uses the existing urethral plate tissue to form a new urethral tube. It has a high success rate and produces consistent cosmetic and functional results in experienced hands.

Mathieu repair is another technique used for distal hypospadias where local flap tissue is rotated to reconstruct the urethra.

Staged repair is used for proximal hypospadias or cases with significant chordee. In the first stage, the curvature is corrected and the tissue is prepared. In the second stage, performed six to twelve months later, the urethra is reconstructed. This staged approach gives the tissues time to heal fully between operations.

Buccal mucosa grafts are used in more complex cases, particularly revisions or proximal repairs where sufficient local tissue is not available. A small graft is taken from the inside of the cheek and used to reconstruct the urethral tube. The donor site heals quickly and without visible scarring.

All hypospadias surgery is performed under general anaesthesia. The procedure takes one to three hours depending on complexity.

How is Epispadias Surgery Performed?

Epispadias repair is more complex than hypospadias repair because it often involves the bladder neck and continence mechanism, not just the urethra.

For penile epispadias without incontinence, the urethra is reconstructed on the correct surface using local tissue, similar in principle to hypospadias repair.

For penopubic epispadias with urinary incontinence, surgery involves reconstructing the urethra, tightening the bladder neck to restore continence, and sometimes addressing the pelvic bone anatomy. This is done in stages and requires close long-term follow-up.

Female epispadias repair reconstructs the urethra and addresses continence at the bladder neck level.

What to Expect After Surgery

In the hospital: Most children are discharged within one to two days after uncomplicated hypospadias repair. Complex or staged procedures may require a slightly longer stay.

The urinary catheter: A small catheter is placed during surgery to allow the urethra to heal around a stable support. For most hypospadias repairs, the catheter stays in place for seven to fourteen days. The surgical team will give specific instructions on catheter care before discharge.

At home: Mild swelling, bruising, and discomfort around the surgical site are expected for the first week. Pain relief is prescribed and the area should be kept clean and dry. Nappies or loose clothing are recommended to avoid pressure on the repair. Baths are usually restricted until the catheter is removed.

Activity restrictions: Avoid any pressure, rubbing, or trauma to the surgical area. Swimming and rough play should be avoided until the doctor confirms full healing, usually at the follow-up appointment after catheter removal.

Follow-up schedule: The first follow-up is usually one to two weeks after surgery, after catheter removal. Further appointments at three to six months assess the urinary stream, healing, and cosmetic result. Long-term follow-up continues through childhood and into puberty, as the adequacy of the repair is also assessed as the penis grows.

When to Call the Doctor After Surgery

Contact the clinic or go to an emergency department promptly if your child shows any of the following after surgery:

  • Fever above 38.3°C (101°F)
  • Swelling or redness that is worsening rather than improving after the first two days
  • The catheter has come out before the planned removal date
  • No urine is draining through the catheter
  • A visible opening or leak appearing along the underside of the penis, which may indicate a fistula
  • Persistent vomiting that prevents the child from taking oral medications

What is a Urethrocutaneous Fistula?

A fistula is a small abnormal opening that can develop along the repaired urethra, allowing urine to leak from a point other than the tip of the penis. It is the most common complication after hypospadias repair, occurring in approximately 5 to 10% of cases.

Parents sometimes notice a second stream of urine or a small hole along the underside of the penis in the weeks after surgery. This does not mean the surgery failed. A fistula can be repaired with a second, simpler procedure, usually done at least six months after the original repair to allow full healing of the surrounding tissue.

Benefits of Surgical Correction

When performed at the right time by an experienced surgeon, hypospadias and epispadias surgery in Bengaluru offers:

  • Normal urinary flow from the tip of the penis
  • Ability to urinate standing up
  • Correction of penile curvature for normal sexual function in adulthood
  • Natural cosmetic appearance
  • Prevention of recurrent urinary tract infections caused by abnormal urine drainage
  • Protection of long-term reproductive health

Risks of Surgery

All surgery carries some risk. For hypospadias and epispadias repair, the risks include:

Urethrocutaneous fistula: As described above, this is the most common complication and is manageable with a second procedure.

Urethral stricture: Narrowing of the repaired urethra can occur and may cause a weak or split urine stream. It is identified on follow-up and can be treated.

Bleeding or infection: Uncommon but possible, as with any surgical procedure. Antibiotics are given at the time of surgery to reduce infection risk.

Need for revision surgery: Some patients, particularly those with proximal hypospadias or complex anatomy, may require a revision procedure. This is discussed openly before surgery so families have realistic expectations.

Anaesthesia risks: Standard for any procedure under general anaesthesia and discussed with the anaesthetist before the operation.

Hypospadias and Epispadias Surgery at Nephro Uro Clinic, Bengaluru

Dr. I. R. Ravish performs hypospadias and epispadias surgery in Bengaluru at Nephro Uro Clinic, located in Jayanagar. He brings over 20 years of dedicated urology expertise and a patient-centred approach that involves clear communication with parents at every stage, from diagnosis through long-term follow-up.

Each child referred to the clinic receives a full assessment before any surgical decision is made. Parents are walked through the diagnosis, the recommended procedure, what to expect during recovery, and the follow-up plan. No decision is rushed.

Nephro Uro Clinic is accessible to families from Jayanagar, Tilaknagar, JP Nagar, Bannerghatta Road, and across Bengaluru and the surrounding region.

To arrange a consultation, contact the clinic directly. Early referral is always beneficial, particularly for families of newborns where surgical timing within the recommended window makes a meaningful difference to outcomes.

Frequently Asked Questions

Yes, both hypospadias and epispadias can be corrected through surgery. Hypospadias repair involves repositioning the urethral opening and reconstructing the penis for normal function. Epispadias surgery corrects the abnormal positioning of the urethra and may involve bladder reconstruction. These surgeries are typically performed in childhood to ensure normal urinary and reproductive function, with high success rates when done by experienced pediatric urologists.

The cost of hypospadias surgery varies based on factors such as hospital, surgeon expertise, and procedure complexity. In India, the price typically ranges between ₹50,000 to ₹2,00,000. Costs may increase for complex cases requiring multiple surgeries. Additional expenses may include hospital stays, anesthesia, and follow-up care. Many hospitals offer packages that cover all aspects of the procedure, making it more affordable for patients.

The ideal age for hypospadias repair is between 6 to 18 months. At this stage, the baby can tolerate anesthesia better, and early correction promotes normal penile development. Performing surgery at a younger age also reduces psychological impact and allows for better healing. However, hypospadias can be corrected later in life if needed. Pediatric urologists assess each case to determine the best timing for surgery.

Hypospadias surgery in India costs between ₹50,000 to ₹2,50,000, depending on the hospital, surgeon’s expertise, and the severity of the condition. Government hospitals offer lower-cost options, while private hospitals provide advanced techniques and specialized care. The cost typically includes surgery, hospital stay, anesthesia, and post-operative care. Patients can also explore insurance coverage and financial assistance options for affordability.

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