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Mrs Kalpana Patil MB BS MS MCh FRCS(Paed)

Consultant Paediatric Urologist

+44 01932 875168

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Hypospadias

1.   What is hypospadias?

2.   How common is it?

3.   Why does my child need the operation to correct hypospadias?

4.   What happens before the operation?

5.   What does the operation involve?

6.   What happens after the operation?

7.   What are the risks of the operation?

8.   When you get home?

9.   What happens next?

10. My Results

 

1. What is hypospadias?

This means that your boy may have the following:

  • The opening through which he passes urine may not be at the tip of the penis. It may be anywhere along the undersurface of the penis.
  • The foreskin is like a hood all at the back and none on the under surface
  • The penis may be bent when stiff

2. How common is it?

1 in 150 boys  have hypospadias. If the father of the child had hypospadias then the chances are high for his son and higher for a second boy as well.

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3. Why does my child need the operation to correct hypospadias?

Dependent on the severity of the problem your boy may be unable to pass urine in the standing position and when older have difficulty in sexual activity.  . All of these can be corrected by the repair of hypospadias. The cosmetic appearance of his penis can also be improved.

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4. What happens before the operation?

The operation will be explained to you in further details, discuss any concerns you may have and ask you to sign the consent form for the operation to say you agree. An anaesthetist will also explain to you the general anasesthetic procedure. Your boy may need to stay 1 night in the hospital.

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5. What does the operation involve?

The aim of the operation is to make sure the penis is straight, to move the opening to nearer the tip of the penis, to rearrange the hooded skin to give the appearance like after circumcision. If the hole is further back on the penis the operation may need to be carried out in stages (at least 2 operations) with an interval of 6 to 8 months in between. This will be explained to you by the surgeon.

This is illustrated in the figures below:

Single stage repair of hypospadias:

  1. Position of the opening on the penis
  2. Formation of the missing bit of the tube with the child’s own tissues
  3. Waterproofing and circumcising the skin

Two stage repair:

  1. First stage or first operation involves removing all the scar tissue and putting a foreskin (patient’s own foreskin) graft on the undersurface of foreskin.
  2. The second stage or second operation is carried out only when the graft has taken well allowing a period of 6 months for it to do so.

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6. What happens after the operation?

Your boy will be brought back to the ward to recover and may need to stay 1 night in the hospital. He will be able to eat and drink soon after the operation.

He will have a large dressing on his penis and a plastic tube (urinary catheter) will be in place in his newly operated urethra to take the urine away from the site of the operation. Both the dressing and tube will be taken down after 1 week on the ward but your boy does not need to be an in patient for that duration.

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7. What are the risks of the operation?

Like many operations there are some complications known with this operation but the surgeon doing the operation is experienced and an expert in the field hence the risk is small.

The opening can come back (1 in 15) and the new opening can become narrow (1 in 50). If the opening comes back your boy will need another operation to mend the opening but only after an interval of 6 to 8 months to allow the tissues to heal. If the opening from where he passes urine becomes narrow it will need to be stretched under a general anaesthetic.

Coincidental infection despite the given antibiotics is usually responsive to a change of antibiotic.

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8. When you get home

Make sure you collect your boy’s medications before going home. He needs at least 4 medicines 1. Oxybutynin this keeps the bladder from being jumpy as the plastic tube drains urine away from the bladder and the bladder is clamped down on the tube irritating it, this is called bladder spasms. 2. Pain killers 3. Lactulose to help him go to toilet easily without the need to strain which may cause discomfort. 4. Antibiotic to prevent infection.

Avoid bathing for 1 week but you may shower him and keep the site of operation dry.
Using double nappies protects from accidental knocks.
If the dressing gets soiled dab any faeces off with a damp cloth

** You need to remember to discontinue oxybutynin 1 day prior to return to the ward for dressing removal so that he will be able to pass urine by squeezing his bladder, oxybutynin relaxes the bladder.

You should contact the hospital if :

  1. Your boy is in a lot of pain
  2. the wound looks red inflamed and feels hotter than the rest of him
  3. there is oozing from the wound
  4. the dressing falls off or gets displaced
  5. the tube stops draining
  6. the tube falls off

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9. What happens next?

Once the dressing is removed the penis looks bruised swollen and unpleasant but this appearance changes with time and in 3 to 4 weeks starts looking like a normal penis.

You will be sent an outpatient appointment to check on your boy’s progress.

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10. My results

I have a complication rate for distal hypospadias following a single stage reapir as follows:

  • Fistula formation 6 – 8%
  • Glans (head of penis) repair breakdown 6 – 8%
  • Meatal stenosis 2 – 3 %
  • Coincidenatl infection 2 – 3 %

Complication rated for 2 stage repair of which the first stage consists of  a preputial graft are as follows:

  • Partial graft uptake (not well taken in some areas  8 – 9%
  • Total graft loss rare
  • Infection despite antibiotics 2 – 3%
  • Fistula formation after 2nd stage repair 6 – 8%
  • Urethral opening sited at the base glans (dependent on the shape of the penis) 5 – 6%

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