Recovery after Hypospadias Surgery (Urethroplasty)

One of the common questions which the parents ask in clinic when I counsel them for hypospadias surgery is “how many days will it take for my kid to recover after hypospadias repair/ surgery”

And my answer though very detailed, could be read two ways

One I am avoiding a straightforward answer and the second may be that I want to give a deeper and more enriching answer which clears all the doubts and answers the question in its whole entirety

The recovery can be of many types.

The immediate and the most concerning is the Recovery from anesthesia and this usually within 2-3 hours after surgery implying that the kid will be able to talk, converse and start taking liquids etc after surgery. Usually after 6-8 hour of surgery kids can take solids and normal diet. We have made sure that our operation theatre and the surgical team is baby friendly to make sure that the recovery is fast and kids go home fast. The anesthesia used is caudal plus sedation in most cases, there is a warming mat under the baby during surgery to prevent low body temperature, the anesthesia team is trained in managing small babies, and all the equipment for anesthesia and surgery is baby friendly. Above all the hospital staff at MITR makes suresthat the child is well cared for and parents are made comfortable during the stay.

Recovery to playing and walking etc usually happens by evening and often I find kids fully comfortable and running around by the morning of day after surgery. That’s also the reason why we moved from bulky dressings and bags- avoiding these and using a double diaper method of managing kids after surgery allows them full freedom of movement.

Recovery from dressings & catheter takes more time. After hypospadias surgery, usually after hypospadias surgery at 4-5 days and catheter after 7-10 days, depending upon the complexity of hypospadias repair. In some distal hypospadias we remove the dressings and catheter at the same time which is at first follow up one week of surgery. This saves unnecessary visits to the hospital. Over all intent is to make hospital visits for the kids as less as possible.

Recovery to a new urethra in the larger sense of passing urine through the new passage happens when the child starts passing urine comfortably which can be expected 2-3 days after removal of the catheter. For the first two or three days there may be little bit of pain in passing urine through the newly formed urethra.

The final recovery happens when the swelling of the penis subsides, the sutures get absorbed and the penis assumes its final shape and thus one can see the cosmetic outcome. This time which the swelling takes to go away may be variable but usually takes up to a month after hypospadias surgery.

Penis is an organ which has a tendency to swell up at the slightest excuse be it a minor infection, injury and this happens quite significantly after hypospadias surgery. Equally importantly the penis is also an organ which heals very fast and almost normal skin cover comes back even after an extensive repair which a lot of penile skin gets rearranged during surgery. Sometimes the penile skin looks very raw and incomplete for some days after surgery but when the patients finally come back after a month it looks like no surgery was done as the skin of penis has an amazing regenerative capacity. Partly this is because of an extensive blood supply of penis skin and partly because of the loose specialized skin.

Especially in kids after hypospadias surgery or urethroplasty, sometimes the penis looks black, blue, swollen and bruised and yet after a month or so everything looks so normal as if just a circumcision has been done.

We have started using specialized Tegaderm and light gauze dressings as these do not impair the blood supply by putting the pressure on already swollen penis after hypospadias surgery. Also, a loose dressing decreases pain and allows tissues to breathe.

Tegaderm is a transparent cling wrap kind of dressing which is very easy to take off and gauze piece is made of soft cotton which is rolled around penis for 3-4 turns and then held with a micropore tape. One more throw of the tape also helps in holding the catheter in place after surgery. These tapes are fairly easy to take off in outpatient clinic mostly by junior staff. Catheter is held by a small fine stitch to the glans and this can b easily cut in outpatient clinic to remove the catheter.