What is hypospadias?
Hypospadias is a birth defect found in boys in which the urinary tract opening is not at the tip of the penis. Bending of the penis on erection may be associated and is known as chordee. Hypospadias occurs in about 1 in 100 to 1 in 200 boys. When we see a boy with hypospadias there is a 20% chance of finding this in another family member such as father or a brother. There are different degrees of hypospadias, some minor and others more severe. We name the types of hypospadias according to their anatomic location, but one must always determine whether or not there is associated chordee.
Why does hypospadias need to be repaired?
Surgical correction of hypospadias involves straightening of any chordee and then extension of the urinary tube (urethra) out to the tip of the penis (the glans). The ability to stand and urinate is important for boys. When the urethra opens before it reaches the glans a boy may be unable to stand and urinate with a direct stream. The youngster who has to sit down to urinate on a toilet is at a painful social disadvantage. A straight penis is necessary for satisfactory sexual function. Although this may not seem to be an important matter in childhood, this is a crucial concern later in life. Early childhood is generally the best time for correction of hypospadias and/or chordee.
How are hypospadias and chordee repaired?
We recommend that the children have surgery to correct hypospadias at about six to nine months of age. Although we try and correct most children with one operation, about 10% will require a second surgical procedure to manage complications. If that is necessary, the second operation is delayed for one year. By performing the first operation early in life, both operations can be completed before the child is finished toilet training.
The operations performed to correct the hypospadias vary according to the degree of abnormality. The extra foreskin is sometimes needed to construct a new urethra. When the operation is completed, the extra skin is removed so the child will look circumcised. To protect the newly constructed urethra (neourethra) the urine is usually diverted with a stent (a silastic tube through the neourethra). We also leave a plastic dressing on the penis, which can be removed by the parent at home.
Post-Operative Care Instructions for Hypospadias
What to Expect After Surgery
After surgery to correct hypospadias, the penis will be completely covered by a clear plastic wrapping, and your child will usually be sent home with a catheter in the bladder that will stay in place for 3 to 10 days. Both the clear plastic wrapping and the catheter should remain in place until you return to the urology clinic. Your urologist will tell you when to return to have the catheter and clear plastic wrapping removed.
Occasionally, there will be an additional dressing over the plastic. If your child has an additional dressing, your urologist will tell you when and how to remove it.
Swelling and bruising are expected after hypospadias surgery. Swelling can take as long as a few months to resolve completely, and bruising typically resolves in two weeks.
How to Diaper Your Child after Surgery
Your child will wear two diapers. We use a double-diapering technique to manage the drainage from the catheter. The external diaper collects urine from the catheter, and the internal diaper catches the stool. After the catheter has been removed, your urologist will arrange to see your child for a follow-up evaluation in 4 to 6 weeks.
After a dirty diaper, stool will occasionally collect under the dressing or around the catheter. This is not an emergency. Do your best to clean the area with soap and water or with a fragrance-free baby wipe.
It is common to see blood in the diaper for the first 24 hours after surgery. A small amount of blood spotting may last for 48 to 72 hours.
Catheter and Dressing Removal
Once the catheter and dressings have been removed in the urology clinic, you may bathe your child normally. Apply petroleum jelly to the penis with each diaper change for 1 to 2 weeks after catheter removal. Please refrain from bouncy or straddle toys for at least 4 weeks after surgery.
After surgery, your child will be prescribed medication for pain control, and they may also be given a low-dose antibiotic to reduce the risk of infection. Your urologist will discuss these medications with you after the operation.
You should call the doctor if your child experiences any of the following:
- Blood soaks through entire diaper or dressing, with continual oozing.
- Catheter stops draining or the outer diaper stays dry for longer than 4 hours.
- Infection symptoms: fever greater than 101° F, spreading/increasing of redness or swelling
- Pain is uncontrolled by pain medications.