Hypospadias Repair In Children

What you should know

  • 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.

Getting Ready

The month before your child's surgery:

  • Your child may need hormone medicine to increase the size of his penis for the surgery. This can be given as a shot or applied on your child's skin as a cream. Ask your caregiver for more information about hormone medicine.

The week before your child's surgery:

  • Bring your child's medicine bottles or a list of his medicines when you see his caregiver. Tell your child's caregiver if he has allergies or any other medical conditions.

  • Your child may need to have blood and urine tests. Caregivers may use ultrasound to check the pathway where his urine passes and other organs. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your child's surgery:

  • Ask caregivers about directions for eating and drinking.

The day of your child's surgery:

  • Write down the date, time, and location of your child's surgery.

  • Ask your child's caregiver before giving any medicine on the day of your child's surgery. Bring all the medicines your child is taking, including the pill bottles, to the hospital.

  • Caregivers may insert an intravenous tube (IV) into your child's vein. A vein in the arm is usually chosen. Through the IV tube, your child may be given liquids and medicine.

  • An anesthesiologist may talk to you before your child's surgery. He may give your child some medicine to make him sleepy before the surgery.

  • You or a close family member will be asked to sign a legal paper (consent form). It gives your child's caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

  • Your child will be taken to the room where the surgery will be done. Medicine called anesthesia will be given to keep him comfortable and free from pain during the 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. 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 cover the incisions, and a tube may be placed in the new urethra.

After your child's surgery:

Your child may stay in a recovery room until he is fully awake. Caregivers will watch your child 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. A caregiver may remove the bandages soon after your child's surgery to check his wounds.

Waiting area:

This is an area where family and friends can wait until your child is able to have visitors. Leave a phone number or other means of contact where you can be reached if you leave the area.

Contact a caregiver if

  • You have questions or concerns about your child's surgery.

  • Your child cannot make it to his surgery on time.

  • Your child has a fever.

Seek Care Immediately if

  • Your child is passing little or no urine.

© 2014 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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