KLES Kidney Foundation
Is surgery required?
Surgery may be required for 2 reasons:
a) To make everything work properly, i.e. to make the urine comes out straight and to make the penis straight.
b) For cosmetic reasons.If the boy can pass urine forwards then the operation is purely cosmetic. However, if it is not there is a risk of your child becoming upset by the appearance as he gets older. Surgical results are best in the first year of life.
When should the surgery be done in ideal circumstances?
Ideal age for surgery in most of the hypospadias is between 6-12 months of age. If there are any co-existing problems then surgery may be delayed till they are sorted out.
Why are the babies operated at such a young age?
Why not wait till they are older?Anesthesia is relatively safe after 6 months of age, that’s why we wait till that age. In infancy the babies are still in diapers, so managing them post surgery at home is very easy for the parents. The catheter can just drip into the diapers and baby can be sent home the evening of surgery or maximum the next day. Further the skin and tissues are very pliable and heal very well at this age. Most importantly, erections and infections are also less of an issue at such a young age. Older kids have painful erections after surgery and also the success rates of surgery are lower in them.
Will there be any problem in the future regarding married life and children?
Most of isolated hypospadias once corrected do not have long-term sequences. Only cases where further investigation is warranted to look for fertility issues are where the hypospadias is very severe, there is associated undescended testis or the gender itself is in question. This can be ascertained by a set of certain investigations which your doctor will explain to you if required.
What are the usual precautions before surgery?
Babies are checked for fitness for anesthesia by a pediatrician/ anesthetist. A couple of blood tests may be required. Any history of bleeding/ blood disorder in the family should be asked. The baby should be free from any infection elsewhere (cold, cough, diarrhea, skin infections etc.). Generally babies are kept empty stomach for 4-6 hours before surgery as it is a requirement for anesthesia. Bathing is advisable in the morning of surgery.
How long does the surgery take?
Surgery time depends upon the severity of the hypospadias. Generally total time spent in the operation room (inclusive of anesthesia time) for a penile hypospadias is between 2-3 hours and more for severe hypospadias
What does surgery involve?
There are many types of operations designed to repair hypospadias. Essentially the operations we use try to bring the hole up to the correct position on the 'head' of the penis (glans), make sure that the penis is straight and repair or remove the foreskin all in one operation. Many moderate hypospadias repair operations can be done as day care procedures (in and out of hospital the same day). Sometimes the child may need to stay in hospital overnight and have a tube (stent) draining the urine for a few days. Our doctor will explain the type of surgery planned for your child.
What is a stent?
The surgeon may decide to leave a tube (stent) into the bladder to drain the urine. This is left in place for 5 to 14 days depending on the details of the operation, and usually simply drains urine into the nappy. A bag can be attached for older children who no longer use nappies. If a stent is used for more than 2 days antibiotics are prescribed to prevent an infection in the urine. The catheter is used to prevent urine running over the internal stitches so that in the first 24 hours there is not so much stinging. When it is removed the child may still find passing urine sore but this gets better in 24 hours. For bigger operations a catheter is used to keep urine from bursting through the stitches for a longer period to help healing. This catheter may irritate the bladder causing spasms in about 10% of cases. The baby cries out about every 30 minutes. If this happens it is easily treated by giving a medicine to stop the spasm.
What is the usual post-operative course?
Babies are usually allowed feeds within 3-4 hours after surgery once they are fully awake and asking for feeds. Initially water and juices are started, if there is no vomiting gradually milk and solids are introduced. Generally, babies are on their usual diet the morning after surgery. Diaper care is taught to the parents by myself and the nurses. Medications (syrups) are explained well and discharge to home happens by evening or morning after. When do we have to come again to the hospital after discharge?First follow-up visit is generally arranged within 5-7 days after surgery for removal of dressing. After removal of dressing, an antibacterial ointment is applied 4-5 times a day and at each diaper change. Depending on the type of surgery done, second visit is arranged at 10-14 days for removal of catheter. A further checkup is done after 3-4 weeks, 3 months and at one year.