Hypospadias, an abnormality of the anterior urethral and penile development, happens when the urethral opening is located above the scrotum or below the penis. Hypospadias repair is the fixing of this birth defect by using the foreskin of the child’s penis to create an extension of the urethra from the abnormal opening to the tip of the penis. This procedure is done when the sons are between six months to two years. It is an outpatient type of procedure.
Sons undergoing the hypospadias repair are given anesthesia which makes him sleepy and numb around the target area. After the surgery, he may be sleepy, feel nauseated, not feel like eating food or drinking fluids, or even throw-up that same day of the surgery. This reaction is usual to anesthesia. Sometimes their sleeping patterns might change by sleeping during the day and wide awake during the night. This change is temporary. He may also experience bruising or swelling on the penis which gets better after a week or two. Full healing is obtained after six weeks.
He may be discharged with a catheter that will be his draining tube until healing is sufficient to sustain urination. The urine drains into his diaper or when older into a urine bag tied on his left leg. In case of urine leaking around the tube or spurting through the catheter is noticed, know this is common and not a problem if most of the urine drains through the catheter. This catheter is needed for the first five to 14 days after the surgery. If there is excessive leaking through the tube it might indicate the catheter is blocked and a call to his urologist will be necessary. An issue with a catheter will be bladder spasms which are uncomfortable. This will be noticed by the child arching his back, bringing his knees close to his check causing urine to squirt through and around the tube. A spot or two of blood on the diaper is usual during this period. If his loose bowel movements stain his surgical dressing, cleaning using soapy water with a washcloth using movements away from the penis is ideal. On the other hand, sons who do not have a catheter attachment may complain of discomfort or cry during urination through the repaired area for one or two days.
After the hypospadias repair, the urologist will prescribe him antibiotics to prevent infection or medication to relax the bladder or cease bladder spasms. Pain medication can also be prescribed if needed. These medications should be accompanied by plenty of fluids because they will cause his mouth to dry. The fluids will keep him hydrated and help clean urine passing the tube.
When it comes to bathing him, sponge baths are ideal until the dressing is removed. A tube bath can be used when the dressing falls off or two days after surgery. He can be bathed in a tube even when the catheter is in. Regular bathing can resume later but using lukewarm water. Scrubbing or washing the penile area is still off limit for healing is not fully reached. When it comes to wearing diapers, using two will provide an added cushion where the inner diaper is for his bowel movements, and the outer diaper is for holding urine. Minimal movements are encouraged to favor healing. Activities like board games, watching TV, walking the toddler in a stroller are encouraged unlike contact sports, bicycle riding, straddling toys, wrestling, gym activities are to be avoided. In case of alarming issues call the pediatric urologist immediately.