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Hypospadias

Information leaflet for parents


Child Health Directorate

Please note that this information leaflet is designed to give an


overview of the experience that you and your son will go through
during his treatment for hypospadias. It is intended to support and
inform further discussion and explanation between yourselves and
doctors prior to giving consent.
What is hypospadias
Hypospadias is a condition of the penis that affects 1 in 300 boys.
The boys urethra (wee tube) is short. It ends on the underside of
the penis, instead of the end of the penis. This results in the boy
not being able to wee when stood up. There are different types of
hypospadias. Although very minor hypospadias may not require
surgery, the vast majority do require surgery. This is usually done
shortly after their first birthday. For particular and individual reasons
some boys have surgery in later years. However, the intention is for
all to have surgery before they start school.

Normal

Glandular

Coronal

Subcoronal or distal shaft

Mid-shaft

Proximal shaft

Penoscrotal

Scrotal

Perineal

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Hypospadias can also be accompanied by “Chordee”. This causes
the penis to curve downwards when erect and may make the penis
appear shorter and bent. Chordee is caused by a tight band of
‘fibrous tissue’ which can pull the penis out of shape.
The foreskin in boys with hypospadias is not fully formed. It is very
important for him not to have a circumcision before the hypospadias
surgery. At the end of the hypospadias surgery most boys would
have a circumcised penis.

What are the benefits of a hypospadias repair?

A hypospadias repair corrects both the Chordee and moves the


urethra (wee tube) to the end of the penis so that the boy:
• Can wee standing up
• Will have a normal looking penis
• Will have a straight penis
• Will have normal sexual function
• Will not suffer psycho-sexual problems when older

What happens when a boy comes to hospital?

• Please see separate leaflet on your child’s admission to hospital


for surgery
• You will be asked to bring in your son the day before surgery
• One of the plastic surgeons will come to see you and your son
• He/She may ask you to sign the consent form for the operation
• He/She will explain to you the procedure and the risks involved
• Your son will be seen by the anaesthetist. Please see separate
information leaflet for general anaesthetic.
• If your son is aged 1 or 2, please bring in nappies his normal
size and nappies one size larger as he may need both sizes after
surgery.
• Request your preference for your son, i.e. cot or bed.
• One parent may stay by their son’s bed side. The hospital provide
a bed

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• Once you have seen the plastic surgeon, the anaesthetist and the
nurse you may be able to go home overnight if you wish and
return the following day for surgery. Your nurse will advise you
when you need to give your son his last food and drink before
surgery.
• Give your son a bath or shower the evening or the morning before
coming to hospital paying particular attention to his penile area.

Operation day

• On the day of the operation you will usually see the consultant or
registrar just before the operation.
• Your son will have a general anaesthetic. Please see parent
information leaflet for general anaesthetic.
• Please note that with anaesthetic and recovery time before and
after the operation, it may be as long as 2 ½ hours before your
son has recovered enough to return to the ward.

After the operation

• There are 3 main types of operation performed by the consultant


for this problem:
• Bracka I ( the first of a two stage repair if it is not possible to do
the hypospadias repair in one stage.) Your son will stay in
hospital for 3 days after this operation. The catheter/stent is then
removed. He will then be discharged but asked to return to ward 5
or 8, on day 6 after his operation. On return a senior plastic
surgeon will then remove some stitches from your son’s penis.
• Bracka II ( the second of the two stage repair.) This happens 6
months after the Bracka I operation. Your son will have to stay
in hospital for a week after his operation. He will have his catheter/
stent removed on the 6th day after surgery. There are no stitches
to be removed after this operation.
• Snodgrass Repair. If it is possible to repair your son’s
hypospadias in one attempt this operation will be done. The post-
operative care for this procedure is the same as for the Bracka II
repair.
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• You will be informed which operation has been done for your son.
You will then be aware of how long your son’s hospital stay will be.

Risks

• Rarely there are early complications like bleeding or infection that


may require further surgery.
• Occasionally many weeks after hypospadias surgery there may
be a urethral fistula (leak of urine from the original opening of the
urethra as well as through the new opening at the tip of the penis
• Urethral stricture (narrowing of the urethra)
• An excess fold of skin
• These conditions could be repaired with further surgery that is
usually minor

Post-operative Care

• Please see separate leaflet for general anaesthetic.


• Your son will have a catheter or stent in his urethra (wee tube)
• A catheter (for boys aged 3 or above) is a fine tube that drains
urine from the bladder.
• A stent (for boys aged below 3) is a finer tube that drains urine
from the bladder. If a stent is used, the urine drains from the stent
into an outer nappy. The inner nappy covers the operation wound
and is only changed when your son has a “poo” (bowel
movement).
• The catheter/stent is in place to prevent urine from leaking onto
your son’s wound (Bracka I) or to keep his new urethra from
closing up (Bracka II or Snodgrass repair)

Your son should not be in too much pain as he is given pain relieving
medication. On the ward we use many different types of medicines
to keep the children as comfortable as possible:
• Paracetamol (pain relief)
• Ibuprofen or diclofenac (pain relief and anti-inflammatory)
• Dihydrocodeine or morphine (pain relief)
• Oxybutynin (for bladder spasm)
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• Ondansetron (if your son is sick)
• Co-amoxiclav ( antibiotic to prevent infection which will be
given until your sons catheter or stent is removed)

Once your son is awake he can have a drink. If he is not feeling sick
he can eat as normal, starting with a light diet. It is very important
for your son to drink as much as possible.

Taking adequate amounts of fluids results in:


• a good flow of urine through the catheter/stent
• preventing the catheter/stent from becoming blocked
• helping to keep the urine clear. Urine may be blood stained for 1
or 2 days after surgery.
If your son is sick after the operation, and cannot manage to drink,
do not worry. If necessary, additional fluids will be given through
a small tube (cannula) into the vein until he stops being sick. This
does not usually last longer than the first day.
Your son will have a dressing over the operation site on the
underside of his penis.

• For the first two days after your son’s surgery he will need to stay
on his bed or on a chair to help the surgical wounds to heal. To
keep him amused, the nurses or play team can wheel his bed
down to the playroom.

Sometimes these boys have difficulty post-operatively in opening


their bowels. To prevent this potential problem, encourage your son
to drink (please bring in his favourite drinks if this helps). Encourage
him to eat fresh fruit, weetabix, vegetables and baked beans or
drink fresh orange juice. Straining to open his bowels may cause
discomfort so it is important to try to avoid constipation if possible.

Discharge following Bracka I

• Your son will usually go home 3 days after his operation once his
catheter or stent has been removed and he has passed urine
twice.
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• He will still have a dressing in place over the graft on the
underside of his penis. This will be held in place with stitches.
• You will be asked to bring your son back to the ward 3 days after
going home. This is for removal of the stitches on the underside
of his penis. A senior plastic surgeon will also check your son’s
wound and graft.
• You will be invited back to the ward one week after your son’s first
graft check for another review by a senior plastic surgeon.
• You will be asked to attend clinic with your son 6 weeks after his
surgery.
• After the operation your son’s penis will look swollen and odd
shaped. It is important to note in boys who have undergone
the Bracka I procedure, their urethra will still be either in the same
position or drop further back as a result of the chordee release.
This appearance is normal for this stage of the procedure and will
be improved once he has his Bracka II repair. However, please
ask your nurse to check if you are concerned.

Discharge Following Bracka II or Snodgrass


Procedure

• Your son will usually go home 6 days after his operation, once his
catheter or stent has been removed and he has passed urine
twice.
• Your son will be invited back to the ward for review by a senior
plastic surgeon one week later.
• You will be invited to attend clinic with your son 6 weeks after his
surgery.
• After this operation your son’s penis will look circumcised, with a
slight scar on the underside
• This scar will fade as he gets older.
• For boy’s whose parents request that the penis not be
circumcised, and there is adequate tissue, the foreskin may be
reconstructed.
• Uncommonly parents may be able to take their son home earlier if
a stent/catheter is not necessary, or if they are comfortable
looking after the stent/catheter at home.
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Caring for your son following discharge home

• If you have any problems, contact the ward at anytime on


01772 522248/523496. Do not go to your GP or A and E unless
advised.
• Give your son a quick bath every day once his dressing has
been removed. Normal soap or baby bath can be used. If there
are any small pieces of dressing remaining on your son, leave
them and let them drop off with time.
• Dress your son in loose underpants, trousers, shorts or
nothing at all! If he is still wearing nappies try to avoid using them
as much as possible. Fasten them loosely as he will find this more
comfortable
• Your son should not get involved in active games, swimming or
cycling until his review in clinic 6 weeks after surgery.
• Your son should not return to nursery until he has been reviewed
on the ward 2 weeks after the operation.
• Give your son paracetamol if required (unless he is allergic to
the drug) as per instructions on the bottle. His wound may be a bit
uncomfortable for a day or two.
• The flow of urine from your son’s penis may come out in a spray
initially. This may continue until the swelling has reduced. The
consultant creates the new urethra when doing the Snodgrass
or Bracka II operation. It is important to note in boys who have
undergone the Bracka I procedure, their urethra will still be either
in the same position or drop further back as a result of the
chordee release. This appearance is normal for this stage of
the procedure and will be improved once he has had his Bracka II
repair.
• Routine follow up appointments will continue until your son
reaches adolescence and this will include psychological support
for you and your son if needed.

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Sources of further patient information:

www.lancsteachinghospitals.nhs.uk
www.nhsdirect.nhs.uk
www.patient.co.uk

Lancashire Teaching Hospitals NHS Foundation Trust is not


responsible for the content of external internet sites.

July 2009 (Review date July 2012)

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