Hypospadias Repair In Children

WHAT YOU SHOULD KNOW:

Hypospadias Repair In Children (Inpatient Care) Care Guide

  • Hypospadias repair is surgery boys have to fix a problem with the penis (male sex organ) called hypospadias. Hypospadias is a condition of the urethra that your child was born with. The urethra is the tube that carries urine from the bladder to the tip (end) of the penis. With hypospadias, the urethra opens on the underside of the penis instead of at the tip of it. In very bad cases, the opening may be on his scrotum (sac hanging behind the penis) or perineum. The perineum is the area between his scrotum and anus (rear end). His penis may also have a condition called chordee (downward curving) and an incomplete foreskin (skin covering the tip). This may make it hard for your child to pass urine and semen in a straight path.

  • The surgery will correct the problems with your child's misplaced urethral opening, curved penis, or misshaped foreskin. During surgery, the foreskin may serve as extra skin to be used in the repair. You may choose to have you child's foreskin circumcised (removed) or repaired to look uncircumcised. Hypospadias repair is usually done when your child is 6 to 12 months old. But it may be done as early as three months, or at 3 to 4 years of age. Having this done when he is very young allows for fast healing and will not interfere with toilet-training. Depending on where the urethral opening is located, your child may have one or more surgeries. Hypospadias repair also helps prevent problems later with having erections and being able to get his partner pregnant.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

  • Your child may bleed more than usual during surgery or get an infection later. His wounds may not heal properly and the path where his urine passes may be blocked. He may develop a small opening from his urethra to his skin called a fistula. Even with surgery, your child's penis may remain curved. He may still have problems passing urine out of his penis. Your child may have problems having sexual intercourse and having a baby when he gets older. He may also be unhappy with how his penis looks.

  • Without surgery, your child may have trouble urinating. He may need to sit down to pass urine, which may affect his self-esteem. When he gets older, he may have problems having sexual intercourse. He may have a hard time getting an erection. He may have problems depositing his sperm, making it hard to have a child. Ask your child's caregiver if you are worried or have questions about your child's surgery, medicines, or care.

WHILE YOU ARE HERE:

Before your child's surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.

  • Emotional support: Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.

  • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.

  • An IV is a small tube placed in your child's vein that is used to give him medicine or liquids.

  • Preoperative care: Medicine may be given to help your child relax. Your child will be taken to the room where the procedure or surgery will be done.

  • Medicine:

    • Anesthesia:

      • Local anesthesia: This is medicine to make your child more comfortable during his surgery. It is a shot of medicine that is put into the tissues where the surgery will be done. It is used to numb the area and dull his pain. He may also be given medicine to decrease bleeding in the area together with the numbing medicine.

      • Caudal anesthesia: This is medicine used to block pain and numb your child below the waist. He may lie on his belly or side while his caregiver puts a shot of medicine in the lowest part of his spine. He may lie on his back with his legs up in stirrups (leg holders). When this type of anesthesia is used, he may also be sedated during the surgery.

      • General anesthesia will keep your child asleep and free from pain during surgery. Anesthesia may be given through your child's IV. He may instead breathe it in through a mask or a tube placed down his throat. The tube may cause your child to have a sore throat when he wakes up.

    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

During your child's surgery:

  • Your child's penis and the area around it will be cleaned and covered with sheets. Caregivers may place a tourniquet (rubber cuff) around his penis to decrease bleeding during surgery. They may use an endoscope to look for other problems in your child's urethra. An endoscope is a long, thin tool that has a light and a video camera at the end. Caregivers will make an incision (cut) around the skin of your child's penis. This loosens the skin from his penis and allows his penis to straighten. Caregivers may then make a new opening for your child's urethra at the tip of his penis.

  • If you child's urethra cannot be formed by bringing together tissues on either side, caregivers will form a flap. They will make two lengthwise cuts near the middle of the underside to form the flap. The sides of the flap are then joined together using stitches to form a tube. A catheter or stent (soft tube) may be placed inside your child's urethra to drain urine. Additional stitches may be needed to form the tip of your child's penis into a cone shape. If you child's hypospadias is very bad, caregivers may use tissue from your child's foreskin or inner cheek. A second surgery may be needed six months later to form the urethra. A dressing will be used to cover your child's penis.

After your child's surgery:

Your child may be taken to a recovery room until he is fully awake. Caregivers will watch him closely for any problems. When caregivers see that your child is OK, he will leave the recovery room. Depending on his condition and type of surgery, he may be taken to his hospital room or allowed to go home. The bandages are used to cover his stitches to keep the area clean and dry to prevent infection. A caregiver may remove the bandages soon after your child's surgery to check his wound.

  • Medicines: Your child may need any of the following:

    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.

    • Anticholinergic medicine: This is medicine to help relax your child's bladder. The bladder is the organ where urine is held before it passes out of the body. This medicine will decrease the discomfort that can come from having bladder muscle spasms (tightening).

    • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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