Passing urine is a natural phenomenon, people do it all the time. The stream of urine has to go straight but can you ever imagine it fall on your foot or come as a fountain all over instead of a single orifice. Imagine this situation which is going to unfold in the following lines.
The patient is eleven years old with a condition called “Hypospadias”. This is a common urological problem that we see quite a bit in our hospital. For every male, the urinary orifice is right at the tip of the penis, whereas in this condition the orifice is on the undersurface of the penis from the tip to the penoscrotal junction or even in the perineum, and if the orifice is not in the right place then the simple art of passing urine becomes a chore.
This young boy had underwent multiple surgical interventions to rectify it since initial years of his life but was not able to achieve what he must have intended to, rather he had complications in form of multiple fistulas.
He came to me in a desperate situation having had 4 surgeries elsewhere and needing a permanent and satisfactory solution to his embarrassing situation. A feeling of foreboding that I at Apollo Children’s Hospital, Chennai would sort out the problem where others had failed, the situation was much more than the mere surgery, when you see parents approaching you choked with emotions.
Normally when there are many fistulas with Meatal Stenosis, we do a staged (multiple steps) surgery to rectify this including a possible graft from the buccal area (i.e. .tissue from inside of the mouth). In this case, the existing fistulas are made into one large fistula after closing the most distal of the fistulas, then the corpus spongiosum is mobilised where we are able to achieve nice closure of the lateral fistulas with a good calibre neo urethral tube. The problem at hand was to have a barrier layer in between the skin and urethra. We did this by mobilizing the scrotal dartos which is a thick and robust tissue to do the barrier job. This was followed by a meatal advancement and the final product was a complete success.
The surgery is slightly unique because of the single stage repair of a crippled penis. Its been almost 6 months since the operation and there are no complications and the patient is passing urine as god intended.
Dr. Jimmy Shad
Consultant Paediatric Urologist
Apollo Children’s Hospitals, Chennai