In the course of last few years of dedicated practice in Pediatric Urology and Hypospadiology, We realized that anxious parents have a lot of questions and they forget to ask many of them when they are consulting us in the clinic. Here I have put down some of these question/ answers and I hope it helps the parents in participating better in the care of their little ones.All in all it's a team effort.

New molecular research, better understanding, long term follow-up data and better surgical techniques have allowed us to offer a more comprehensive approach including counseling, planned surgical correction and appropriate gender assignment in these babies.

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. Most of the 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.

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 type 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 slightly painful 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.

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 the doctors and the nurses. Medications (syrups) are explained well and the discharge back home happens by evening or morning after.

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, a 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.

  • Pain: Most of the time the babies are slightly cranky but manageable. They feel better at home, that is why we try to send them home as soon as possible. It is also easier for the parents to manage them at home. Further an analgesic (pain-killer) syrup is prescribed to help in pain relief.
  • Spasms: Babies may have intermittent spasms due to irritation by the catheter. For this reason a small dose of bladder relaxant is usually prescribed. The dose may need to be adjusted if cramps still happen.
  • Blood spotting in the diaper/ catheter may occur in the first few days. A few drops of the blood are acceptable. In case of continuing ooze, a hospital visit may be required, but this is very infrequent.
  • Dressing issues: Dressing loosening up may occur in some babies. If it happens during first 2-3 days, then a new dressing is placed. After that, the dressing is just removed.
  • Infection may happen and is the most common cause of the failure of surgery. To prevent this, broad spectrum antibiotic syrup is usually prescribed for 7-10 days. It is vital to prevent stool smearing up the dressing in immediate post-operative period.
  • Fistula: Fistula is a small area of breakdown in the operated area, leading to sideways leakage of urine. Small, off centre fistulas may heal in due course of time, if the tip of the new urethra is not tight. Others may require repair 6-9 months later. The rate of fistula in experienced hands, in penile hypospadias is typically 5%.
  • Stenosis/ Stricture: During healing period, the new urinary tube may become tight. Mostly this happens at the tip of penis and can be easily managed by daily calibration at home with a small feeding tube. Sometimes, if the repair becomes too tight, then a second surgery may be required.

We at hypospadias foundation specialize in managing children with previously failed surgeries done elsewhere. If a part of the urethra is salvageable and the penis is straight – then local flaps with good blood supply are used for giving a predictable good result. Dr Singal & Dr Dubey have performed more than 25 such surgeries for kids with failed surgeries elsewhere. If the previous urethra is totally unusable or the penis is still bent (chordee) – an extensive 2-3 stage procedure like buccal mucosa grafting and then urethroplasty may be required. Buccal mucosa refers to the lining of the inside of cheeks or lips, which is biologically closest to urethral tissues and adapts well to use in urinary system. This procedure is often the last resort typically in children with previously failed 3-4 surgeries. With growing experience, the requirement for such procedures has become less.

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