Hypospadias repair means a surgery. Surgery word itself is very scary and it requires a lot of courage and faith for the parents to handover their little one to the surgical team and we know that it is not easy for parents to hand over their young kid for a surgery. Lot of things goes around in the parent’s minds about risks, results and safety of both surgery and anesthesia.
Here are some tips, learnings and guidance for parents while preparing for Hypospadias Surgery for their child
Before the meeting the Doctor
- Most cases of Hypospadias are detected at birth. The Pediatrician at birth may not be expert enough to guide further so it’s better to consult a Pediatric Urologist or expert hypospadias surgeon as soon as possible.
- There is no benchmark for earlier consultation, but it is better to visit to the Pediatric Urologist when the child is less than 6 months old.
- If you are an outstation patient and are communicating with the doctor over emails ensure you share following info:
- Baby’s Allergies and medications
- Any special medication or condition
- Any hospitalization and the reason
Sometimes this information doesn’t affect the course of hypospadias surgery but it is always safe to share as this helps the anesthesiologist for planning a safe anesthesia.
- If you have a limited timeframe for your visit then
- Check if there are any further tests (like blood or urine tests) or investigations required before you meet the pediatric urologist
- As required by the doctor, perform the tests and send the reports to doctor for further guidance. This can be done via email.
- Sometimes a certain blood count such as hemoglobin may be needed to be normal before hypospadias repair procedure is required to perform before surgery and if the count is not as preferred it may take month to reach the desired level.
- A thorough history is taken for any evidence of infection, other illness and any familial disorders. A complete blood count and a urine test is done to check for body parameters. A pediatrician consult is often taken for a systemic examination. Chest xray is no longer recommended routinely before elective surgery if the chest examination is normal.
- Check for the travel plans of the hypospadias specialist surgeon so that it doesn’t clash with your visit. This makes sure that both you and the surgeon arrive at a date when the surgeon is not travelling and is available for the post-operative care as well.
- Convey your travel plans to the doctor
Once you meet the hypospadias doctor, most of your doubts will be cleared and questions answered in the initial meeting. A date for hypospadias surgery will be decided in the meeting. If you have questions or doubts regarding the hypospadias treatment procedure please ask the doctor, he will be happy to guide. Sometimes you may have doubts or questions post consultation check with the doctor and you can email for such doubts. The doctor may suggest hospitalization before the day of the surgery and also some additional tests whenever needed.
Hospitalization
- Admission: In a hospital with daycare facility, we admit the child for hypospadias operation at 6:30am -7am. If the parents live farther away from the hospital or the hospital doesn’t have a daycare facility, we like to admit the children the night before surgery. At Hypospadias foundation in Navi Mumbai, India we mostly admit the children in the morning of the surgery itself unless the parents live more than 50km away or do not have a means of traveling early in morning. Before admission to the hospital
- Reach hospital half an hour before the scheduled time.
- Insist – the cannula and blood tests be done once the child is settled in the room
- Request for the allotment of room and fulfill all the formalities
- Ask for hospital clothes for the baby
- Change the baby in hospital clothes
- Once the child is settled than ask doctor on call to the needful
- Carry baby products – wipes, diapers, any special food or milk powder you may be giving, soft toys which soothes them
- Carry you basic requirements for one to two days of hospitalization
- Since the hypospadias operation will be done under anesthesia, check till when the child can be given food/water/milk, generally this is 4-6 hours’ time period.
- Clothes: Children are changed into hospital clothes appropriate for their age on the morning of surgery. Make sure that the iv canula is inserted after changing of clothes.
- Sedation: If the child is irritable while staying hungry we either advise a pacifier or a light sedative syrup till the time of anesthesia.
- Induction: Crying child is not a good sight just before hypospadias surgery for the parents or the hypospadias doctor. If the child has an iv line, anesthesia team often administers a small dose of premedication to help sedate the child before shifting to operation theatre.
- Consent: Before hypospadias surgery is started, family has to fill up an anesthesia and a surgery consent form which is quite detailed in general. Sometimes the parents get alarmed on seeing the form. But please feel free to ask us about any doubts which you have. We always have the best of intentions and efforts to get your baby back home safely after hypospadias surgery.
After Care for Hypospadias surgery
- Learn to change the baby double diaper. We were happy as with double diaper technique the babies were nicely tugged in and there was little fear of catheter dislodgement.
- Learn the medications of the baby
- Don’t discontinue medication unless the doctor advise
- Follow up visits with the doctor
The child will have discomfort and can be cranky due to operation the doctor will guide you. This is a normal phase after any surgery with children as penis is a sensitive organ pain may be there for a first few days. But as one learned person said “This too shall pass.