When is hypospadias surgery done?

Hypospadias repair is surgery to correct a congenital defect where the opening of the urethra is on the underside of the penis. The opening may be located either near the head, referred to as distal, or from the middle of the penile shaft to the base of the penis or even behind the scrotum. This is referred to as proximal. Often hypospadias surgery includes correction to chordee (downward curvature of the penis) if it exists and either a circumcision or reconstruction of the foreskin.

Hypospadias surgery is done most often between 6 and 18 months

When is hypospadias surgery done? Hypospadias surgery is most often done when boys are between 6 and 18 months old. The surgery is typically outpatient and the baby can typically go home the same day. The exception is in more severe cases when a buccal mucosa (lining of the cheeks and the back of the lips) graft is necessary for additional operative skin. In this case, an overnight hospital stay helps to ensure the graft site can heal without infection and the baby can be monitored. Boys who are born with hypospadias should not be circumcised at birth. The extra foreskin tissue may be needed in the repair.

Hypospadias repair

Before surgery, children will receive general anesthesia. This will make them sleep and unable to feel pain during surgery. Once the child is a little older, “silly juice” is used in pre-op to relax the child and so that nurses can him from mom without much anxiety. Mild hypopspadias may be repaired in one procedure. Severe hypospadias may need two or more, staged procedures.

During surgery, the surgeon will use a piece of foreskin or tissue from another site, such as the back of the lips, to create a tube that increases the length of the existing urethra. Extending the length of the urethra will allow it to open at the tip of the penis. In cases where the existing urethra has been excised, a full new urethra will be created from the baby’s tissues.

During surgery, the surgeon may place a catheter (small tube) in the urethra to help hold its new shape. The catheter may be sewn or fastened to the head of penis to keep it in place. This will be removed 1 – 2 weeks after surgery.

Most of the stitches used during surgery will dissolve on their own and will not need to be removed. Some surgeons prefer the use of double diapers while the catheter is in place, and others don’t. Some use bladder spasm medications to help with spasms caused by the catheter, and others don’t. Ultimately, this is up to the severity of the condition, age of the child and surgeon preference.

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