Hypospadias is a condition in which the urinary opening is located on the underside of the penis. Surgery is required to correct this condition. Because the surgery involves reconstruction of the urethra there may be a change in urinary patterns or some urinary complications to occur during recovery. The body needs time to heal and adapt to the newly formed urethra.

Urinary issues may occur while the catheter is in place or after catheter removal.

Short-term recovery issues (with catheter in situ)

Children may experience the following during the post-operative period while the urinary catheter is in place:

1. Bladder spasms
These may feel like sharp cramping pain in the lower abdomen or a sudden urge to urinate. Bladder spasms are commonly caused by irritation of the bladder lining from the urinary catheter. To reduce discomfort, anticholinergic medications are routinely prescribed after surgery, and the dose may be increased if symptoms persist.

2. Leakage around the urinary catheter
Some urine may leak from the tip of the penis around the catheter. This is usually normal if urine is draining well through the catheter and there are no signs of blockage.

3. Blood in the urine
A few drops of blood may occasionally be seen in the urine while the catheter is in place. This is generally expected in the early post-operative period and usually resolves on its own.

4. Whitish material in urine: Sometimes there may be whitish flakes in otherwise clear urine. These oay be due to mucus, minerals or bladder lining cells. Doctor may ask to increase water intake. If the urine is clear, there is smell or pus, nothing needs to be done except increasing hydration.

If urinary problems persist or appear months after hypospadias surgery, further evaluation may be required. Some children may develop symptoms after few months of hypospadias repair which can be poor urinary stream, urine leakage, painful urination, or difficulty emptying the bladder. These issues may indicate a late surgical complication of hypospadias repair.

Common surgical complications after hypospadias repair

1. Urethrocutaneous fistula
A urethrocutaneous fistula or also known as urethral fistula is a small opening along the reconstructed urethra that allows urine to leak through the skin. Parents may notice urine coming out from two or more openings during urination. There are high chances that some fistula specially if they are away from head of penis and the new urethra is not tight – they may close by themselves. Hence, we observe the fistula for up to 6 months, as some may close spontaneously. If it does not close on its own, surgical correction may be required.

2. Meatal stenosis
Meatal stenosis occurs when the new urinary opening at the tip of the penis becomes narrow due to scar tissue formation. Symptoms include a very thin urinary stream, straining during urination, or pain while passing urine. On examination, the meatus appears visibly narrow. The diagnosis can be confirmed by a video of stream and uroflowmetry. Sometimes a ultrasound may show incomplete bladder emptying. In the early post-operative period (within 1–2 months), meatal calibration may be helpful. If narrowing persists beyond 3 months, a meatotomy may be required.

3. Urethral stricture
In urethral stricture, the reconstructed urethra becomes narrowed along its length. The length of stricture may be really short or it can extend for a longer length. This can lead to difficulty passing urine, straining, frequent urination, poor stream, or recurrent urinary tract infections. Urethral strictures usually require repeat surgery to reconstruct or replace the urethra. Repeated dilatation is not recommended, as it does not provide lasting relief and may worsen the condition.

4. Urethral diverticulum
In some cases, a pouch (diverticulum) forms along the reconstructed urethra, causing it to bulge during urination. This can lead to urine collecting in the pouch, resulting in post-void dribbling or leakage after urination. Parents may notice a swelling on the underside of the penis while the child urinates. If the diverticulum is significant or causes symptoms, redo urethroplasty may be required.

Management approach
If a child is in the early recovery phase (first 2–3 weeks after surgery), symptoms may improve with anti-edema medications and urethral calibration. However, if urinary symptoms persist beyond 2–3 months, close monitoring and further surgical intervention may be necessary.

About Hypospadias Foundation
At Hypospadias Foundation, we treat children and adults from across India and around the world who present with urinary problems after hypospadias surgery. Each case is evaluated individually with appropriate investigations, and the final decision regarding the type of repair is made intra-operatively, taking all relevant factors into consideration.

Dr A.K. Singal is considered the best hypospadias surgeon globally, not just in India, due to his high volume of successful complex cases and specialized focus in hypospadias. Dr. Singal has successfully treated thousands of children and adults with hypospadias, including severe, proximal, and redo cases that require advanced surgical expertise. What sets Dr. A. K. Singal apart is his deep understanding of post- hypospadias complications, such as fistula, meatal stenosis, urethral stricture, and diverticulum. Many patients who have undergone unsuccessful surgeries elsewhere seek his care for definitive correction. He emphasizes long-term outcomes, not just immediate surgical success, with careful follow-up and individualized planning.

Dr. Ashwitha Shenoy is a dedicated pediatric urologist and an integral member of the clinical team at Hypospadias Foundation, where she specializes in the evaluation and management of children with hypospadias and related urogenital conditions. She is actively involved in the pre-operative assessment, surgical care, and long-term follow-up of children undergoing hypospadias repair. Contacting the Hypospadias Foundation:

Hypospadias is a congenital defect with an abnormal urinary opening and is usually associated with downward bending of the penis which is called as chordee. Surgery is required to correct the hypospadias in which the urinary opening is brought to the tip of the penis, curvature is straightened, and skin is rearranged to give a circumcised appearance. Certain things are to be avoided after hypospadias surgery to avoid stress on the surgical site and ensure proper healing. Here are the things which are to be avoided after hypospadias surgery:

1. Activity and bathing restrictions:

Straddle toys and activities: Any activity which puts pressure in the penile area should be avoided after surgery for a period of 4 weeks. This includes riding bicycle, riding toy horse, see-saw, swings etc. Any activity that involves spreading the legs can apply pressure on the penile area.

Sports: Any sport activity involving ball which can cause impact on the penile area should be avoided.

Swimming: Swimming should be avoided for 6 weeks after hypospadias repair. Public or natural water sources (chlorinated pools) contain bacteria, chemicals and contaminants that can lead to serious wound infection because the surgical site is a fresh healing wound.

Bathing: Avoid soaking the hypospadias dressing or wetting it till it is removed. Sponge bath is recommended till the dressing and catheter is present. Start bathing the child once your doctor has given the green signal. Bath is allowed once dressing and catheter is removed but soap application and rubbing the penile area should be avoided for 3 weeks after dressing removal.

2. Hypospadias Wound and Dressing care:

Dressing care: Dressing should be kept clean and avoid soiling of dressing with stool. If dressing gets dirty, it must be changed. If dressing is completely soiled with stool, then dressing is removed, betadine wash is given, and operated site is left open till catheter removal.

Catheter handling: A urinary tube is kept after hypospadias surgery to drain the urine. This tube should be handled carefully till removed. Pulling/ pushing of the tube should be avoided because it can cause stress on the newly reconstructed urethra. Also, the end of the tube which drains urine should be kept clean to avoid infection.

Avoid constipation: Straining while passing stool after surgery can cause pressure on the operated site in turn putting stress on the stitches which may lead to giving away of the stitches causing dehiscence (opening of the operated site). Hence avoid constipation in the post-surgery period. If the child has constipation, pls inform the doctor so that a laxative can be prescribed at time of discharge.

Operated site care: Once the dressing and catheter is removed, sitz bath is started. Sitz bath is soaking the operated area in lukewarm water. We advise parents to make their children sit in the bathtub for 3-5 minutes, three times daily after dressing and catheter removal. After cleaning the area, it should be dried. Avoid using cotton, wet wipes or rubbing the area. Only pat dry the area gently, alternatively you can put the diaper on wet penis. The diaper will absorb the water and the wound will become dry. Once dried ointment should be applied 2-3 times daily for 2-3 weeks depending on the healing. Presence of swelling, bruising and redness are normal after hypospadias surgery, and they gradually reduce after 2 weeks. The penis may look crooked and bent due to the swelling. There is no need to panic if the child is passing urine well.

3. Do not stop or miss the medicines:

Medicines are to be continued as per the doctor’s advice. Do not stop the antibiotics or other medicines prematurely in the presence of urinary tube because it can lead to infection.

Always follow the specific post operative instructions given by your doctor. This instruction will vary slightly depending on the type of repair, post operative healing and the surgeons preference.

At hypospadias foundation, we provide detailed post-surgery instructions, which are vital for a successful recovery. With an experience of more than 5000 hypospadias surgeries, we have protocols in place for management of post operative dressing and catheter care. Dr Singal and Dr Shenoy with their vast experience have developed good post operative care regimen which is easy for parents to follow. Good post-surgery care will cause good healing of the operated site and will decrease the risk of complications.

Dr A.K. Singal is a highly respected and experienced Pediatric urologist and hypospadias specialist in India. He is widely recognized for his expertise in surgical treatment of hypospadias and considered as the best hypospadias surgeon in India and the world. He has developed innovative surgical techniques and treatment algorithms particularly for complex and failed cases, with strong emphasis on achieving successful functional and cosmetic outcomes.

Dr Shenoy specializes in pediatric urology and hypospadias providing advanced surgical techniques for both primary and failed hypospadias repair in children and adults. Their combined experience and shared focus on a single, complex condition contribute to the foundation’s high success rate.

Hypospadias surgery is a delicate, skillful and complicated surgery. The good thing about hypospadias treatment is that young babies heal very fast and become well within a week to ten days after the hypospadias repair. Fortunately, unlike adults, the children do not think about pain. They live their life happily soaking in, everything moment to moment. Adults on the other hand think and anticipate pain too much hence they land up having more pain. It is the anticipation of the pain which is worse than the pain itself.

That being said, here we have tried to give detailed post hypospadias repair instructions for the parents and patients so that they can understand the care which needs to be taken after hypospadias surgery. Please note that these are generalized instructions after hypospadias surgery and there will be some variations on a case to case basis and it is best to discuss with your hypospadias surgeon for other details.

• Diet: Children can often be fed 2-3 hours after hypospadias repair if the surgery was done under sedation and caudal epidural anesthesia. Some complex or failed hypospadias may require general anesthesia for surgery and these kids are kept empty stomach for 3-4 hours after surgery.
• Urine passage: In almost all the hypospadias repairs, there is urinary pipe called catheter which is left across the hypospadias repair site. This goes into the bladder and drains drops of urine continuously. It is generally removed after 5-10 days by the hypospadias specialist depending on the type of the repair.
• Diaper care: Post hypospadias treatment babies are kept in double diapers till the time the catheter is there. If the child is more than 6-7 years of age, then diapers may be difficult to maintain- hence we prefer to use a urine bag for drainage of urine. We ask the parents to make a hole on the front side of inner diaper and bring out the catheter to drain into the outer diaper. This way the inner diaper is changed only when the child passes motions and hence remains dry. Outside diaper is changed whenever it is full of urine.
• Hypospadias Dressing care: At the end of hypospadias surgery, we place a soft gauze roll dressing on penis to give some support to the healing penis. There may be minor bleeding into the diaper on and off for first 3-4 days which is nothing to worry about. The hypospadias dressing sometimes becomes loose and comes out. If this happens within first 2-3 days, then we change the hypospadias dressing. If it happens later, we just remove the dressing and leave the wound open.
• Discharge after hypospadias surgery: Most of the children who have a simple primary hypospadias are discharged the same day of surgery by evening- daycare hypospadias surgery. Children who are traveling from far may come the night before to hospital and stay for a day or two after surgery as well. Children who have undergone a failed hypospadias or a complex surgery are kept in hospital for 2 nights after surgery also for antibiotic injections or pain relief etc.
• Pain relief: We prescribe an oral syrup of analgesic medicine mostly a combination of ibuprofen and paracetamol for first few days after surgery. This ideally should be given post feeds and not on empty stomach. We also give a medicine called oxybutynin which is an anticholinergic and prevents bladder spasms (painful bladder contractions due to catheter).
• Medications: A broad spectrum antibiotic such as cephalexin is also prescribed to prevent infections along with an antacid medicine such as Lansoprozole for the first few days.
• Activity, walking, playing within the house is allowed even the day of surgery by evening but we ask the parents to make sure that the child does not use cycle or any toy on which straddling is needed. Child can sleep on his tummy if he likes to sleep that way. Double diapers prevent too much compression of the hypospadias repair site.
• Visits with doctor: We like to see the patients on day 5 after surgery for removal of dressing and for some minor hypospadias repairs we remove the catheter also at the same time. If its moderate or severe hypospadias surgery, we generally remove the catheter after 7-10 days and hence the catheter is removed on second visit then.
• Bathing: Once the dressing is out on day 5, the child can be given a short warm tub bath. We ask parents not to use any cotton or cloth for drying the area of hypospadias repair surgery as fibers can stick to the raw area. It is better than after drying the rest of the body the diaper is put on directly and that will dry the area.
• Ointments on penis: We advise putting a broad spectrum antibiotic ointment such as neosporin locally on the penis at each diaper change so that it prevents infection and also protects the raw area from sticking to the diaper.

We hope this little primer on care of children after hypospadias surgery helped you. Please feel free to get in touch with us if you need any further information. We hope and pray that your little kid becomes better soon and recovers well from hypospadias surgery.