Before surgery, a doctor has to evaluate a patient with hypospadias. The initial evaluation involves localizing the meatus, inspecting the foreskin, and evaluating for chordee. Chordee is a condition where the head of the penis is curved either downwards or upwards.
The main purpose of hypospadias repair is to make sure that an individual’s penis is straight and that the meatus is as distal as possible to create a forwardly-directed stream of urine. There are several principles that may be used to help with hypospadias repair. These include:
- Skin coverage
Different categories of hypospadias repair
Hypospadias repair can generally be categorized into four types of repairs:
- Urethral advancement procedures
- Tubularization of the urethral plate
- Substitution or supplementation of the urethral plate with local tissue or skin flaps
- Substitution or supplementation of the urethral plate with grafts
Are there any complications during hypospadias repair?
Even after several attempts at hypospadias repair, individuals may still suffer from functional complications. The complications vary widely depending on the initial hypospadias repair method that was used. The complications can include any of the following conditions:
- Urethrocutaneous fistula formation
- Urethral stricture
- Persistent hypospadias
- Hair in the urethra
- Urethral stones
- Penile shortening
- Penile curvature
The complication rate may be slightly influenced by the number of years that a surgeon has been practicing. For example, there’s a decrease in the rate of fistula occurrence for every year a surgeon gains practicing. The volume of hypospadias repairs also affects the success rate. Averagely, most of the adult men who present for hypospadias repair have in the past undergone three previous attempts at repair.
Complications arising from hypospadias repair are a very important topic for discussion in reconstructive urology. This is because of the best practices for managing these complications are not established then the men are at a greater risk of needing multiple hypospadias surgeries.
Discharge after hypospadias repair
Usually, hypospadias repair happens in children. These happen as soon as possible to fix a birth defect whereby the child’s urethra doesn’t end at the tip of the penis. The type of procedure that’s done depends on the severity of the defect. Hypospadias repair may be the first surgery to cure the condition or a follow-up procedure. Precise post-operative instructions should be given by the health provider.
After discharge from the hospital, it’s normal for the child to want to sleep all the time and not have the urge to eat because he might still be feeling nauseated from the surgery. Expect the penis to remain swollen and bruised for a couple of days. Full healing takes about 6 weeks.
The boy will need to use a catheter for about 5-14 days after the surgery. If the catheter is not put in after hypospadias repair, urinating may be uncomfortable for the first couple of fays. Here’s some additional information about the catheter:
- It’s held in place by stitches which are removed once the catheter has been removed
- It drains into the child’s diaper or bag that remains taped to his leg. Sometimes urine leaks when he pees and the parent might spot blood in the urine – this is nothing to worry about.
- It may induce bladder spasms which may hurt but aren’t dangerous.
After hypospadias repair, the doctor prescribes some antibiotics to prevent infection, painkillers, and meds to relax the bladder and stop bladder spasms. Give the boy sponge baths until the dressing is off after which it would be okay to bath the child in warm water and ensuring to pat the area dry. The parent needs to call the doctor if the child has trouble urinating or if the swelling keeps getting worse.
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