Dealing with complications
Risk of complications after any surgical procedure is a fact of life. Unfortunately, due to the fragile tissues involved, hypospadias carries a higher risk than other standard surgical procedures. The stats range from 6 to 30%. Pretty much, the more severe your little one’s hypospadias the higher the risk of the complications. This is because with more distal hypospadias, the surgeon is essentially extending the length of the existing urethra and the likelihood of other issues to fix, such as chordee, undescended testes, a shortage of tissues requiring a graft, or a dorsal hood requiring reconstruction, is lower. Complications depend on severity of the hypospadias, the surgical technique used, the size of the penis, the age of the child, and the experience of the surgeon.
Dealing with complications of hypospadias repair
Urethrocutaneous fistulas are the most common complications of hypospadias repair.
Fistulas are the one I hear of the most from moms. A fistula is essentially a leak between the new urinary channel and the skin of the penis. Fistulas usually show up between one to six weeks after surgery. If a fistula develops, a second shorter surgery may be necessary. In addition to waiting for postoperative healing, oftentimes surgeons wait to see if the fistula will resolve on its own.
Urethral strictures are the second most common complications of hypospadias repair.
A urethral stricture or meatal stenosis is a tight spot or narrowing somewhere along the new urinary channel. This most often occurs at the tip of the penis or at the opening of the urethra. The chance of a stricture developing depends on the type of surgery used. If a stricture develops a second shorter surgery may be necessary.
Other complications: necrosis, edema, infection, bleeding, or stent related problems.
Unless immediate reoperation is needed for bleeding, infection or debridement, reoperation for complications are done at least 3 to 4 months and ideally six months following the last surgery. This will provide the original surgery ample time to heal and essentially shake out anything that will happen in the healing process. Overall, the incidence of complications can be minimized by surgical expertise, preoperative planning, choosing the right technique, operating in early childhood, and judicious postoperative management. But sometimes even with the best surgeons and the most judicious management, complications happen.
If you’re going through complications of hypospadias repair now with your little one, hang in there, stay strong and don’t give up. Try to find the best surgeon you can to reduce the risk of unnecessary additional complications and scarring.
Reach out to me if you need support. I’ve been there.