Caring for your child after hypospadius repair surgery (1951)

Key points below

Caring for your child after surgery

What is hypospadias?

The urethra is the tube that carries urine from the bladder to the outside of the body. Hypospadias is when the male urethra opening is not on the tip of the penis. The opening is somewhere along the underside of the penis.

What causes it?

In most cases, the cause of hypospadias is not known. There is an increased risk of having this disorder if other male members in the family have it.

How is it treated?

Most often, hypospadias is repaired by surgery when your son is between 6 to 12 months of age. At birth your son will not be able to have a circumcision, as the extra foreskin may be needed for the repair.

What happens on the day of surgery?

A nurse will call you 2 to 3 days before the surgery. The nurse will give you instructions about when your child must stop eating and drinking. It is very important that you follow these instructions. The surgery will be canceled if these are not followed.
Once your child is under anesthesia (asleep), the anesthesiologist or the surgeon may give your child a shot of pain medicine. The shot will go through the tailbone or at the surgery site. This will help your child wake up comfortably and without pain.
Plan on spending several hours at the hospital or Surgicenter for this outpatient surgery. Most likely, your son will go home the same day.

What happens after the procedure?

Dressing Care

Your son's penis will have a dressing on it. Try to keep the dressing clean. You do not need to remove or change the dressing.
If your son wears diapers and has a bowel movement that soils the dressing, gently rinse the dressing off with warm water.
If the dressing falls off, leave it off. Do not try and put it back on again.

If there is a drain tube (stent)

There may be a small tube, called a stent, coming out of the tip of the penis. The stent lets urine flow out of the bladder without coming in contact with the area operated on. This helps the urethra heal.
If your son wears diapers, he may need to wear two of them. This is called double diapering. The stent should go out the side of the inner diaper. The second diaper is put over the first one to absorb urine from the tube. When the outer diaper gets wet, change it as you normally would. The inner diaper is to collect stool, change it as needed. A nurse will show you how to do this if double diapering is needed.
If your son is toilet-trained, the stent will be attached to a small bag to hold the urine. Check the bag every few hours and empty it when it is no more than half full. The nurse will show you how to do this.
You will come to clinic about one week after surgery to have the stent removed. Give your son a dose of pain medicine before you come to the clinic for this visit.

Bathing

Do not let your child take a tub bath or shower until after the follow-up visit. A sponge bath may be given and the dressing may be rinsed off if it is soiled.

Pain

There will be some pain after surgery. Stronger pain medicine may be needed at first. In most cases, acetaminophen (Tylenol®) is all that is needed after 2 or 3 days. Follow the directions the doctor gives you to help manage your son’s pain.
Some children have bladder spasms after surgery. These are pains that come and go. Check the stent to be sure that it is not kinked and that urine is dripping freely. Call if the spasms don’t stop after you checked to see that there is not a problem with the stent.
Limit your child's activities and give your child plenty of liquids. This will help prevent bladder spasms.

Diet

Do not force your child to eat during the first 12 hours after surgery. Give small amounts of clear fluids such as apple juice, broth, Jell-O® or Popsicles® often. This will help to avoid an upset stomach.
When your child feels well after taking clear fluids, offer soft foods such as soup, pasta, yogurt, ice cream or pudding. Slowly return to a normal diet over 1 to 2 days.

Activity

Your child may feel sleepy or groggy for 1 to 2 days after surgery. Let your child rest or play quietly. Older children can read books, color, watch TV or play quiet games. Infants and younger children may want to be held more than normal.
Most regular activities can be started again after the follow-up appointment.
Your child should avoid rough play, swimming and straddle toys for 3 weeks after surgery.

Talk to the doctor about when your child can go back to day care or school.

Infection
You may be given a prescription for antibiotic medicine. Be sure your child takes the medicine. Your child should finish all of medicine unless the doctor tells you to stop.

Complications

Complications from the surgery may include:

Wound infection or bleeding.
Scarring at the urethral opening.
The penis continues to be curved.
Separation of the repair.
Concern about how the repair looks. More surgery may be needed.
A leak in the new urethra (fistula) occurs in 2 to 25% of repairs. The risk is highest in the most complex repairs. Fistulas will need more surgery about 6 months after the first surgery.

Most complications are found soon after surgery, but some may take years before they are seen.

Pediatric Urology:

Monday – Friday 8:00am – 4:30 pm, Phone: (414) 266-3794
Monday – Friday 4:30pm – 8:00am and weekends , Phone: (414) 266-2000

For other health and wellness information, check out this resource: https://kidshealth.org/ChildrensWi/en/parents

ALERT

Call your child’s doctor, nurse, or clinic if you have any questions or concerns or if:

The stent comes out.
Urine does not drip freely after checking the stent to see if it is kinked.
The outer diaper stays dry or the urine bag is empty for more than 2 hours.
The inner diaper has urine in it.
Your child has a temperature higher than 101° F (38.5° C).
The dressing comes off before the follow-up visit.
The dressing is too tight.
Your child has pain that is not helped by medicine or gets worse.
Has special health care needs that were not covered by this information.