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Hypospadias Repair

Definition

This surgery is used to treat a condition called hypospadias . This is a birth defect of the penis and urethra. The urethra is the tube that connects the bladder to the outside of the body so that urine can exit. With hypospadias, the opening of the urethra develops on the underside of the penis. The goal of surgery is to put the opening of the urethra at the tip of the penis. After surgery, the penis should function normally.
The Male Reproductive System
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Reasons for Procedure

The surgery is done to treat male children born with hypospadias. The condition can make it difficult for the child to urinate while standing. It can also affect sexual function later in life.
The surgery is typically done at age 3-18 months old. It can also be done in older children and adults. In infants with hypospadias, circumcision should not be done. Tissue from the foreskin may be used if surgery is done to correct the hypospadias.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If your child is having a hypospadias repair, the doctor will review a list of possible complications, which may include:
  • A new opening on the underside of the penis called a fistula, causing urine leakage
  • Scarring/narrowing of the urethra that makes it difficult to urinate
  • Need for more surgery
  • Bleeding
  • Reaction to the anesthesia
  • Infection—wound infection or urinary tract infection
  • Psychological trauma
Discuss these risks with the doctor before the surgery.

What to Expect

Prior to Procedure

The doctor may do the following:
  • Physical exam
  • Imaging, blood, and urine tests
  • Discuss the anesthesia being used and the potential risks
Talk to the doctor about your child’s medications and supplements. Your child may need to stop certain medications before the surgery. The doctor may also ask that your child take certain medications to prepare for surgery.
Your child will need to have an empty stomach before the procedure. Ask the doctor when your child will need to stop eating.

Anesthesia

General anesthesia is used during surgery. This will keep your child asleep and block any pain.

Description of Procedure

This is usually done in an outpatient setting. Your child will not need to stay in the hospital overnight.
Your child will be prepared for surgery. IVs will be placed in his arms for medications and fluids. Several techniques may be used to reconstruct the urethra. The doctor will attempt to use existing urethral tissue to:
  • Divert the tube to the correct position
  • Widen the tube if needed
Tissue may be taken from the foreskin or mouth to reconstruct the urethra. Incisions and graft procedures may also be needed to loosen certain areas of tissue to straighten the penis or correct other problems. A temporary catheter or stent may be placed in the penis for up to two weeks. This will allow your child to urinate. Bandages will be placed around the penis.
More complex cases may require a two-stage surgery approach.

How Long Will It Take?

1-½ to 3 hours

How Much Will It Hurt?

Your child will be asleep during surgery. He will not feel any pain. After the procedure, the doctor will give your child pain medication.

Post-procedure Care

At the Care Center
The staff will provide care to make your child more comfortable and promote recovery. Pain medications and antibiotics may be given. Swelling at the surgery area is normal.
During your stay, the hospital staff will take steps to reduce your child's chance of infection such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your child's incisions covered
There are also steps you can take to reduce your child's chances of infection such as:
  • Washing your hands and your child's hands often and reminding visitors and healthcare providers to do the same
  • Reminding your child's healthcare providers to wear gloves or masks
  • Not allowing others to touch your child's incisions
At Home
When your child returns home, do the following to help ensure a smooth recovery:
  • Give your child medications as directed.
  • Encourage light, gentle play while the penis is healing.
  • Change the drainage bag or diaper as directed.
  • Keep the bandaged area clean, dry, and protected. Bandages will be removed at your child’s first visit after the procedure.
  • Ask the doctor about when it is safe for your child to shower, bathe, or soak in water.
  • Follow all of the doctor’s instructions.

Call Your Child’s Doctor

After arriving home, contact the doctor if your child has any of the following:
  • Pain that is not controlled with medication given
  • Redness, increased swelling, or tenderness in the penis
  • Signs of infection, including fever and chills
  • Nausea or vomiting
  • Inability to eat or drink
  • Difficulty urinating or cannot urinate
  • Catheter or stitches fall out
In case of an emergency, call for medical help right away.

RESOURCES

American Academy of Pediatrics http://www.healthychildren.org

American Urological Association http://www.auanet.org

CANADIAN RESOURCES

Canadian Urological Association http://www.cua.org

Health Canada http://www.hc-sc.gc.ca

References

Hypospadias. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 14, 2013. Accessed December 2, 2013.

Hypospadias/chordee. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/info/urinary/diagnose/hypospadias.htm. Updated June 2013. Accessed December 2, 2013.

Hypospadias: guidelines in pediatric urology. AHRQ, National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=12594. Accessed December 2, 2013.

Revision Information

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