Safe Surgery for Children with Hypospadias

One of the important concerns for parents when their little ones are advised a surgery for hypospadias (urethroplasty), are risks associated with surgery. These concerns are true for a kid who is undergoing surgery for hypospadias as well. Safety is the foremost factor for parents while deciding a surgery for their kid.

Same concern is valid for doctors (Pediatric Urologist, Anesthetist) and hospital team also. In some sense the safety checklist and precautions are important for any surgery which we plan to do in a child.

The risks mainly stem from anesthesia which is needed for performing a surgery in a child. There are other risks associated with Hypospadias surgery itself but none of them are life threatening.

To make surgery and anesthesia safe, the following precautions are undertaken:

1. Pre-operative checkup for fitness: Blood and urine tests are done to make sure that the child is fit enough to undergo surgery and does not pose an increased risk of anesthesia. This also includes a thorough clinical examination to make sure that there is no infection lurking anywhere. In presence of any obvious infection such as cough, running nose, fever, diarrhea, skin infection etc it is better to postpone the surgery till the child recovers fully from infection. Infection leads to higher chances of infection at operated site and also slows down healing as body’s energy is spent in fighting the infection and thus healing takes a back seat.
2. Sterile precautions: Instruments are properly sterilized the day before surgery and packed properly. The operation room is disinfected the evening before and locked. All sterile aseptic precautions are followed during scrubbing, draping etc.
3. Availability of proper pediatric anesthesia equipments: Appropriate sized anesthesia equipment such as breathing tubes, masks, connectors, tapes, syringes, intravenous canula, intravenous infusion sets, needles, well calculated & checked anesthetic medicine doses etc are kept ready and labeled. Every single dose should be cross checked and labeled. Emergency medical equipment is cross checked before every single case and kept ready.
4. Prevention of low body temperatures during surgery: Small children tend to lose a lot of body heat under cold environs of the operation theatre and thus get cold during surgery. The low body temperatures are called hypothermia. This can lead to multiple complications such as prolonged recovery from anesthesia, higher risk of infections and shivering. Hypothermia is best prevented – the steps taken are blanket to cover legs and upper body leaving only the lower tummy till mid thigh exposed for surgery, head cap and warm bandage rolls on arms and legs, electronic warming blanket underneath the baby set at 37-38 degrees, using warmed disinfectants, setting the AC temperatures to 25-26 degrees and not keeping them too low and then keep less operative area exposed and covering the rest of it with surgical drapes. For Hypospadias anyway a small area is exposed after preparing the middle part of the body with disinfectants.
5. Dedicated Surgical equipment for kids: These include miniaturized microsurgery urethroplasty instruments, small retractors, small sutures (almost as fine as hair), fine clips, suction apparatus and smaller drapes. Larger instruments can crush the delicate tissues of kids and lead to poor surgical outcomes.
6. Trained professionals: Doctors and nurses handling the kids undergoing surgery should be well trained in understanding that the kids are not small adults, their body behaves differently, the drug does should be perfect . The doses have lesser error margin and thus need to be calculated, cross checked and properly labeled. Putting an intravenous line requires training for handling kids and most importantly the Pediatric Urologist surgeon and the anesthetist should be very well trained in managing kids. Even a small excess of intravenous fluids during surgery can lead to major complications, that is the reason why pediatric infusion sets and connectors are very different from those in adults.
7. Baby friendly environs of hospital: At MITR Hospital & Hypospadias foundation, we ensure that the kids are kept happy and engaged by the staff and the doctors during their hospital stay.

Happy kids have a faster & better healing and this also decreases the complications of surgery.