What is Hypospadias surgery?
Hypospadias is a common condition in which the meatus (opening) of the penis is dislocated from its normal position, i.e., near the tip of the glans (head) and is located under the penis.
According to the Journal of Pediatric Urology, the prevalence of hypospadias is highest in North America (34.2 per 10,000 births) and lowest in Asia (0.6–69 per 10,000 births).
The condition can only be fixed with the help of hypospadias repair surgery. Hypospadias repair surgery aims to straighten the penis as well as move the meatus to the glans of the penis.
The procedure typically entails the following steps:
- Moving the meatus to its standard location
- Straightening the shaft of the penis, if curved
- Circumcising any abnormally formed foreskin
The procedure lasts between one to three hours, and most children go home on the same day as the procedure.
A question often raised concerning hypospadias surgery is regarding the recovery time. Here is a comprehensive guide on what to expect after the surgery and how you can care for your child at home.
After the surgery: what to expect?
Some children who undergo hypospadias repair surgery require stent placement. A stent is a plastic tube that is placed in the penis at the end of the surgery. Its purpose is to help drain the urine from the bladder without letting it come in contact with the surgical site.
The stent is secured into place either with the help of tape or a stitch. It is removed one to two weeks after the procedure.
The stent may get displaced or fall out at home. If your child can urinate properly, you need not be concerned. If, however, your child is experiencing pain or discomfort, consult your doctor immediately for assessment.
Some children require the placement of a catheter following surgery. A catheter is a plastic tube that extends into the bladder to help discharge the urine out of the body. A catheter is placed depending on the complexity of the procedure.
There are two main types of catheters used for the task, namely the Foley catheter and the suprapubic catheter.
The suprapubic catheter helps drain urine into an attached bag and is rarely used. It is surgically placed between the bladder and the outside of the belly. It is used approximately a week after the stent or Foley catheter is removed from the urethra.
Fever and pain are the most common post-op symptoms in most children for a few days after the surgery. For this reason, the doctor may prescribe ibuprofen or acetaminophen to your child.
Antibiotics are also a routine part of the prescription to prevent the risk of infection. The doctor may prescribe more potent painkillers, such as morphine, in case of severe pain.
There is also a possibility of a little bleeding at the incision sites as well. It is normal if you find some blood on your child’s diaper for a few days after the procedure.
If, however, you find a lot of bright red blood or witness active bleeding, apply pressure to the bleeding site and rush to the hospital immediately for emergency care.
Post-op diet and activities:
Hydration is essential following any surgical procedure. Your child will require plenty of fluids, more than he usually would.
It should be noted that some medicines prescribed post-op, such as morphine, comes with specific side effects like constipation. Constipation must be avoided at all costs as it would entail the application of too much pressure by the child to defecate. This pressure may result in pain and discomfort for the child.
For this reason, he might require stool softeners to help induce smooth bowel movements. Aside from stool softeners, you must ensure that your child is taking a high fiber diet to prevent further constipation, including fruits, whole grains, etc.
Encourage quiet play and avoid contact sports. If your child is older, avoid engagement in strenuous activities for up to three weeks. These include swimming, bike riding, wrestling, etc.
The presence of the catheter in the bladder sometimes may result in spasms. Spasms are not only uncomfortable, but they may also result in urine leakage.
Medication, such as Ditropan, helps manage the issue. An alternative is to allow the catheter to leak freely—excessive leakage signals towards a blocked tube. If the leakage cannot be controlled, consult your doctor immediately.
Note: Ditropan comes with a few side effects such as dry mouth and flushing of the face. Do not panic if you observe any such symptoms. Ensure that your child is ingesting fluids to combat the issue.
As is the case with any surgery, follow-ups are essential with hypospadias surgery as well.
One to two weeks after the surgery, the stent is removed, and the surgical site is left to heal. It is prudent to observe the urinary stream after the tube is removed. Spraying of urine is normal. However, if you observe a thinning stream, contact your doctor immediately.
A follow-up visit is usually scheduled a month after the tube is removed to check for progress. Approximately three months post-op, the child is brought in for another follow-up to assess how well the wound is healing. Additional appointments can be arranged for the future if the need arises.
Signs that require urgent care
Hypospadias surgery, although a simple and safe procedure, can present with some alarming post-op symptoms that require immediate attention.
If your child exhibits any of the following signs after the procedure, consult your doctor immediately. These include:
- Fever more than 101° F
- Excessive pain
- Excessive bleeding
- Difficulty urinating
- Suppressed appetite
- Increased irritability
- Continuous vomiting
- Increased redness on the penis
- Changes in urination
When it comes to recovery, it is imperative to understand that healing is non-linear. Our bodies vary, and so do our healing patterns. If you are looking for a tentative answer, then three months is a good estimate regarding recovery time and progress.
The usual follow-up period is up to two years after the surgery. It is because complications, if any, are expected to appear by this time. You should consult your doctor about any further concerns that you may have regarding the procedure.