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­­When Your Child Needs Surgery for Hypospadias

Your child needs surgery on his penis to help it look and work normally. You may feel scared for your child and have many questions. Learn what to expect by reading this sheet. Also, discuss any questions or concerns you may have with your child’s healthcare provider. Baby lying on back with diaper on. Hole is cut in diaper over penis. Catheter comes through hole. Second diaper is being placed over first diaper and catheter.

What Is Hypospadias Surgery?

Your child has hypospadias. This means your child’s urethra doesn’t reach the tip of the penis. As a result, the opening of the penis (urethral meatus) is located in the wrong place. Surgery can correct this. It can also be done to correct how the penis looks. A number of methods to repair the penis can be used. Your child’s surgeon will choose the best method for treating your child. During the procedure, the surgeon will do the following:

  • Correct the urethra so it reaches to the tip of the penis

  • Move the urethral meatus to the tip of the penis

  • Straighten the penis, if needed

  • Correct how the penis looks

The surgery is usually done by a pediatric urologist. This doctor specializes in the diagnosis and treatment of urinary tract problems in children.

When Is the Surgery Done?

Surgery is typically done when the child is between 6-18 months old. In less severe cases, the surgeon is often able to correct the problem with one surgery. In other cases, more than one surgery is needed. These are done about 6 months apart.

The Surgical Experience

The surgery lasts about 2-4 hours. It takes place in an operating room at a surgery center or hospital. Here’s what to expect before, during, and after the surgery:

  • Before surgery: You will be given instructions about feeding your child before the procedure. Follow these instructions about eating and drinking carefully.

  • The day of surgery: You will be able to stay with your child until he is taken into the operating room. You’ll then go to a waiting room until he is out of surgery. An anesthesiologist gives your son medication so he sleeps and does not feel pain during the surgery. Special equipment monitors your child’s heart rate, blood pressure, and oxygen levels. Once your child is asleep, the surgeon will begin the procedure. The urethra is corrected so it reaches the tip of the penis. This may be done using the foreskin or a small amount of tissue from another area in the body. A tube (called a catheter) will likely be placed into the urethra at the head of the penis. This allows urine to drain freely while the penis heals. The catheter is removed when it’s no longer needed.

  • After surgery: Your child will be taken to a recovery room to recover from the anesthesia. You will be able to see him at this time. Nurses monitor your child’s breathing, blood pressure, and pulse. They also give your child medication to manage his pain. Your child may be able to go home the day of the surgery. The doctor will tell you when it’s okay to take your child home.

Healing After Surgery

Your child may have a stitch at the tip of his penis to hold the catheter in place. The catheter will stay in the penis until your child’s doctor removes it. Ask the doctor how long the catheter will remain in the penis. You will also notice other stitches used to correct the hypospadias. These stitches don’t need to be removed. They will dissolve on their own in time. As the penis heals, you will notice swelling, redness, scabbing, and bruising. This is normal. It takes about 3-6 months for the penis to heal completely.

Caring for Your Child at Home

To care for your child:

  • Care for the tube and bandage as you have been instructed. Your child’s health care provider will tell you whether to change the child’s bandage and how to do this. Follow all care instructions for the catheter and dressing carefully.

  • Manage your child’s pain by giving him prescribed medication. Follow your health care provider’s instructions carefully. It’s best not to wait until pain gets bad to give the medication. Your child may be in pain if he:

    • Is irritable.

    • Cries a lot.

    • Refuses to eat or drink.

    • Grabs at the incisions.

  • Give prescribed medication to your child as instructed. Some medication (antibiotics) may be given to fight infection. Other medication may help keep your child’s bladder relaxed while the catheter is in place.

Double Diapering

Double diapering is a technique that may be used to keep the affected area dry and to keep poop (stool) off the catheter. It also helps protect your child’s penis as it heals. To double diaper:

  • Cut a hole in the first diaper for the tube to pass through.

  • Pass the tube through the hole.

  • Then place a second diaper on your child. This diaper will absorb urine as it drains from the tube.

 

Call your child’s health care provider if your otherwise healthy child has any of the following:

  • In an infant under 3 months old, a rectal temperature of 100.4°F (38.0°C) or higher

  • In a child 3 to 36 months, a rectal temperature of 102°F (39.0°C) or higher

  • In a child of any age who has a temperature of 103°F (39.4°C) or higher

  • Your child has had a seizure caused by the fever 

  • Vomiting

  • Refusal to drink

  • Pain not controlled with medication

  • Incision that bleeds and doesn’t stop

  • Catheter that isn’t draining urine or falls out unexpectedly

  • No catheter in place and isn’t urinating

 

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