When Your Child Needs Surgery for Hypospadias

What is hypospadias surgery?

Child's penis with penis pointing up to show underside. Foreskin surrounding glans is hooded and drapes over tip of penis. Dimple in tip of penis. Three holes along underside of penis in center from glans to scrotum show possible sites of urethra opening.
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 doctor specializes in the diagnosis and treatment of urinary tract problems in children.

When is the surgery done?

Surgery is typically done when the child is between 3 to 18 months old. More than one surgery may be needed.

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 son medicine so he sleeps and does not feel pain during the surgery. Special equipment watches 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 a recovery room to recover from the anesthesia. Nurses watch your child's breathing, blood pressure, and pulse. They also give your child medicine to manage his pain. 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.

Baby with two diapers and catheter showing double diapering technique.
Cut a hole in the first diaper for the catheter to pass through.

Caring for your child at home

To care for your child:

  • Care for the tube and bandage as you have been instructed. 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 instructions 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 instructed. 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. 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 your otherwise healthy child has any of the following:

  • Fever (see "Fever and children," below)

  • 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

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds of digital thermometers. They include ones for the mouth, ear, forehead (temporal), rectum, or armpit. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Use a rectal thermometer with care. It may accidentally poke a hole in the rectum. It may pass on germs from the stool. Follow the product maker’s directions for correct use. If you don’t feel OK using a rectal thermometer, use another type. When you talk to your child’s healthcare provider, tell him or her which type you used.

Below are guidelines to know if your child has a fever. Your child’s healthcare provider may give you different numbers for your child.

A baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

A child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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