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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. Once the diagnosis is made, circumcision is not done. Tissue from the foreskin may be used during surgery.

    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 penis forms, causing urine leakage
    • Scarring/narrowing of the urethra (making it difficult to urinate)
    • Need for more surgery
    • Bleeding
    • Reaction to the anesthesia (eg, light-headedness, low blood pressure, wheezing)
    • 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 medicines and supplements. Your child may need to stop certain medicines before the surgery. The doctor may also ask that your child take certain medicines 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 medicines 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 medicine.

    Post-procedure Care

    At the Care Center
    The staff will provide care to make your child more comfortable and promote recovery. Pain medicines and antibiotics may be given. Swelling at the surgery area is normal.
    At Home
    When your child returns home, do the following to help ensure a smooth recovery:
    • Give your child medicines 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 medicine 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.aap.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/index-eng.php/

    References

    Agency for Healthcare Research and Quality (AHRQ), National Guideline Clearinghouse. Hypospadias: guidelines in pediatric urology. AHRQ, National Guideline Clearinghouse website. Available at: http://www.guideline.gov/content.aspx?id=12594 . Accessed August 13, 2010.

    Borer J, Retik A. Hypospadias. In: Wein AJ, ed. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 125.

    Cincinnati Children’s Hospital. Hypospadias/chordee. Cincinnati Children’s Hospital website. Available at: http://www.cincinnatichildrens.org/health/info/urinary/diagnose/hypospadias.htm . Accessed August 16, 2010.

    DynaMed Editorial Team. Hypospadias. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 2, 2010. Accessed August 19, 2010.

    Mayo Clinic. Hypospadias. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/hypospadias/DS00884 . Updated January 22, 2009. Accessed August 13, 2010.

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