Hypospadias Repair Surgery

The penis plays two important roles in males by being a pathway both for urine and semen (sperm) to leave the body. Both fluids go out through a tube called the urethra (yoo-REETH-ra), which opens at the end of the penis. Sometimes, while the baby is still in his mother’s body, this opening fails to develop completely to the end of the penis and may instead be located anywhere along the underside of the penis. This condition is called hypospadias (hi-poe-SPADE-ee-us), and it is congenital (con-GEN-it-ool), meaning that your child was born with it. Many times children with hypospadias may also have an abnormal bend of the penis shaft, and a partially developed foreskin, the fold of skin at the end of the penis. The hypospadias repair surgery will reposition the opening and give the penis a more normal appearance.

When hypospadias is corrected early, most boys have no memory of having it at all; yet even older boys usually have no problems with the surgery. Once they’ve healed, most boys have little noticeable scarring from the surgery. A successful hypospadias repair as a child should last a lifetime, including during periods of rapid penis growth during puberty.

General anesthesia (an-es-THEEZ-ya) makes your child’s whole body go to sleep and is needed for hypospadias repair so that his reflexes will be completely relaxed.  General anesthesia makes the surgery easier and safer to do because your child will not feel any pain or have any memory of it.

Caudal anesthesia is given with general anesthesia to block pain in the low back, belly and lower trunk area. It allows the anesthesia doctor to give a smaller amount of general anesthesia during the surgery, and also provides up to 4 hours of pain relief in that area after the surgery.

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery. One business day before your child’s surgery, you will receive a phone call from a surgical nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.

• The nurse will give you specific eating and drinking instructions for your child based on your child’s age. Following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse. 

For children older than 12 months:

• After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, chewing gum or candy.

For infants under 12 months:

• Up to 6 hours before the scheduled arrival time, formula-fed babies may be given formula. 
• Up to 4 hours before the scheduled arrival time, breastfed babies may nurse.

For all children:

• Up to 2 hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®­, Kool-Aid® and juices you can see through, such as apple or white grape juice. Milk is not a clear liquid.
• In the 2 hours before scheduled arrival time, give nothing to eat or drink.
• You may bring along a “comfort” item—such as a favorite stuffed animal or “blankie”—for your child to hold before and after the surgery.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to keep your child calm is for you to stay calm.

Once your child has been registered for the surgery, a nurse, nurse practitioner or physician’s assistant and a member of the anesthesia staff will meet with you to take your child’s vital signs, weight and medical history. As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.

• The anesthesia doctor will review your child’s medical information and decide which kind of sleep medication he should get.
• If your child is very scared or upset, the doctor may give him a special medication to help him relax. This medication is flavored and takes effect in 10 to 15 minutes.
• If you wish, you may go with your child to the room where the surgery will be done and stay as the sleep medication is given.
• Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake.
• Older children may choose between getting their medication through the mask or directly into a vein through an intravenous (IV) line.
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the surgery.
• After the IV has been placed, your child will be turned onto his side. The lower back near the spine will be cleaned for the caudal anesthesia injection.

In addition to the abnormal opening in the urethra, boys who are born with hypospadias may have an underdeveloped foreskin (the skin on the end of the penis), and the penis may appear to be curved.

The surgery to repair it usually involves these steps:

• Creating the rest of the urethra or tube that did not form to the end of the penis;
• Moving the opening of the urethra to the end of the penis; 
• Straightening the shaft of the penis if it is curved; and
• Circumcising (removing) the abnormal foreskin of the penis.

Some complicated cases of hypospadias may require more extensive surgical repair.

While your child is asleep, his heart rate, blood pressure, temperature and blood oxygen level will be checked continuously.

• Your child may have a breathing tube placed while he is asleep. If a breathing tube is used, your child may have a sore throat after the surgery.
• To keep your child asleep during the surgery, he may be given anesthetic medication by mask, through the IV tube or both. When the surgery is over, the medications are stopped and your child will begin to wake up.

When your child is moved to the recovery room, you will be called so that you can be there as he wakes up.

• The doctor who did your child’s surgery will meet with you to talk about the surgery and answer any questions you might have.
• The caudal anesthesia will allow your child to wake up comfortably, without any pain from the surgery.
• Your child will need to stay in the recovery room to be watched until he is alert and his vital signs are stable. The length of time your child will spend in the recovery room will vary because some children take longer than others to wake up after general anesthesia.
• Children coming out of anesthesia may react in different ways. Your child may cry, be fussy or confused, feel sick to his stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off.
• Some children will wake up with a catheter (CATH-it-er), a thin flexible tube placed in the urethra to allow urine to flow out from the bladder. Your surgeon will determine when the catheter should be removed.
• Children who have received caudal anesthesia may have some weakness, numbness or tingling in their legs. These feelings are normal and should go away within a few hours. You should watch your child closely for a few hours to prevent tripping or falling.

After your child is discharged and goes home, he may still be groggy and should take it easy for the day.

• If a dressing was used, you will be told how to care for it. An ointment may be recommended or prescribed for you to use with the dressing.
• Your child will be restricted from bathing for several days after surgery.
• You may use baby wipes to gently clean your child, if necessary.
• Your surgeon will determine when your child may resume normal activities.
• Complete, in-depth instructions will also be given to you by your surgeon prior to discharge.
• Your child may begin to eat and drink a little at a time and resume normal eating and drinking as long as he is feeling well.
• If you notice a fever higher than 101.4˚F, bleeding or foul smelling drainage from the area around the repair, call the doctor who did the surgery right away.

If your child has any special needs or health issues you feel the doctor needs to know about, please call your doctor’s office before the surgery and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.