When Your Child Needs Surgery for Hypospadias

What is hypospadias surgery?

With hypospadias, the opening of the urethra is located on the underside of the penis or near the scrotum.

Your child has hypospadias. This means his 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 fix this. It can also be done to correct how the penis looks. 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 often done by a pediatric urologist. This is a specialist in the diagnosis and treatment of urinary tract problems in children.

When is the surgery done?

Surgery is usually done when the child is between 3 to 18 months old. In some cases, the surgery may be done in stages.

The surgical experience

The surgery lasts about 2 to 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. Follow any directions your child is given for taking medicines and for not eating or drinking before surgery.

• 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 or nurse anesthetist gives your child medicine, so he sleeps and does not feel pain during the surgery. Special equipment keeps track of your child's heart rate, blood pressure, and oxygen levels. Once your child is asleep, the surgeon will start the surgery. 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 lets urine drain freely while the penis heals. The catheter is removed when it's no longer needed.

• After surgery. Your child will be taken to the postanesthesia care unit to recover from the anesthesia. Nurses closely watch your child's breathing, blood pressure, and pulse. They also give your child medicine to manage pain if necessary. Your child may be able to go home the day of the surgery. The healthcare provider will tell you when it's OK 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 healthcare provider removes it. Ask your child's provider how long the catheter will stay in the penis. You will also notice other stitches used to correct the hypospadias. As the penis heals, you will notice swelling, redness, scabbing, and bruising. This is normal. It takes about 3 to 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 directed. Your child's healthcare 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 medicine. Follow your healthcare provider's directions carefully. It's best not to wait until pain gets bad to give the medicine. Your child may be in pain if he:

  • Is irritable

  • Cries a lot

  • Won't eat or drink

  • Grabs at the incisions

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

Double diapering method

Double diapering is a way to keep the affected area dry and to keep stool off the catheter. It also helps protect your child's penis as it heals.

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

To double diaper your child:

• 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.

When to call the healthcare provider

Call your child's healthcare provider if any of the following occur:

• Fever greater than 100.4°F (38°C), or as directed by your healthcare provider

• Vomiting

• Won't drink liquids

• Pain does not go away with medicine

• 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

How to take a child’s temperature

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.