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Hypospadias repair
Definition
Hypospadias repair is surgery to correct a birth defect in boys in which the urethra (the tube that carries urine from the bladder to outside the body) does not end at the tip of the penis. Instead, it ends on the underside. In more severe cases, the urethra opens at the middle or bottom of the penis, or in or behind the scrotum.
Alternative Names
Urethroplasty; Meatoplasty; Glanuloplasty
Description
Hypospadias repair is usually done when boys are between 6 months and 2 years old. It is done on an outpatient basis. It rarely requires an overnight stay in the hospital.
Boys who are born with hypospadias are not circumcised at birth, so their foreskin can be used for the repair during surgery.
Before surgery, your child will receive general anesthesia. This will make him sleep and unable to feel pain during surgery. Mild defects may be repaired in one procedure. Severe defects may need two or more procedures.
The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of your son's urethra. Extending the length of the urethra will allow it to open at the tip of the penis.
During surgery, the surgeon may place a catheter (tube) in the urethra to make it hold its new shape. The catheter may be sewn or fastened to the head of penis to keep it in place. It will be removed 1 - 2 weeks after surgery.
Most of the stitches (sutures) used during surgery will dissolve on their own and will not have to be removed later.
Why the Procedure Is Performed
Hypospadias is one of the most common birth defects in boys. This surgery is performed on most boys who are born with hypospadias.
If repair is not done, your son may have:
- Problems controlling and directing his urine stream
- A curve in the penis during erection
- Problems with fertility
Surgery is NOT needed if the condition does not affect normal urination while standing, sexual function, or the deposit of semen.
Risks
Risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
Risks for any surgery are:
- Bleeding
- Blood clot
- Infection
Other risks for hypospadias:
- A hole that leaks urine (fistula)
- Large blood clot (hematoma)
- Scarring or narrowing of the repaired urethra
Before the Procedure
Your child's surgeon may ask for a complete medical history and physical exam of your child before the procedure.
Always tell your child's doctor or nurse:
- What drugs your child is taking
- Include drugs, herbs, and vitamins you bought without a prescription.
- Tell them about any allergies your child has to medicine, latex, tape, or skin cleaner.
Ask your child's doctor which drugs your child should still take on the day of surgery.
On the day of the surgery:
- Your child will usually be asked not to drink or eat anything after midnight the night before surgery.
- Give your child any drugs your doctor told you to give your child with a small sip of water.
- Your child's doctor or nurse will tell you when to arrive for the surgery.
- The doctor will make sure your child is healthy enough for surgery. This means your son should not have any signs of illness. If your son is ill, the surgery may be delayed.
After the Procedure
Right after surgery, your son's penis will be taped securely to his belly so that it does not move.
Often, a bulky dressing or plastic cup is placed over the penis to protect the surgical area. A urinary catheter (a tube used to drain urine from the bladder) will exit the dressing to allow urine to flow freely into the diaper.
Your child will be encouraged to drink fluids so that he will urinate. Urinating will keep pressure from building up in the urethra.
Your son may be given medicine to relieve pain.
You will probably be able to take your child home the same day as the surgery. If you live a long way from the hospital, you might want to stay in a hotel near the hospital the first night.
Your healthcare provider will explain how to take care of your son at home after leaving the hospital.
Outlook (Prognosis)
This surgery lasts a lifetime. Most children do well after this surgery. Your son's penis will look almost or completely normal. It will also work almost or completely normally.
If your child has a complicated hypospadias, he may need more operations to improve the penis' appearance or to repair a hole or narrowing in the urethra.
Follow-up visits with a urologist (a doctor who specializes in the treatment and surgery of the urinary system) may be needed once your son has healed from surgery. Sometimes a visit is needed when boys reach puberty.
References
Snodgrass WT. Hypospadias. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 130.
Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 539.
Kraft KH, Shukla AR, Canning Da. Hypospadias. Urol Clin North Am. 2010;37:167-181.
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
