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Surgical correction of hypospadias

Published by Bupa's health information team, August 2008.

This factsheet is for parents who are considering surgical correction to treat their son's hypospadias, or for people who would like information about it.

Hypospadias is a condition that affects the development of your son's urethra. It causes the opening through which your son passes urine to develop in the wrong place (short of the tip of his penis). Surgical correction involves creating a urethral opening in the correct position and straightening his penis.

Your son's care will be adapted to meet his individual needs and may differ from what is described here. So it's important that you follow the surgeon's advice.

About hypospadias
What are the alternatives to surgery?
Preparing for your son's operation
About the operation
What to expect afterwards
Recovering from surgery
What are the risks?
Questions and answers
Related topics
Sources

About hypospadias

Hypospadias is a congenital condition (present from birth). It affects the development of your son's urethra, leaving the opening through which he passes urine (meatus) short of the tip of the penis. The urethra is the tube for passing urine and semen out of the body. It runs from the bladder through the prostate gland and along the centre of the penis.

There are a number of different types of hypospadias depending on where the opening is positioned:

glanular hypospadias - opening is within the head of the penis (glans)
coronal and subcoronal hypospadias - opening is just below the glans
penile hypospadias - opening is on the shaft of the penis
penoscrotal hypospadias - opening is close to the scrotum (the loose bag of skin containing the testicles that hangs below the penis)

The position of the opening also means your son may have:

a hooded foreskin - the foreskin doesn't develop properly on the underside of his penis, creating a hood of skin at the top
chordee - the skin on the underside of his penis is too tight so it appears bent, especially when erect

The further back your son's urethral opening is, the more severe these will be.

Surgical correction is used to create a urethral opening at the tip of your son's penis, straighten his penis and, in general, make it look as normal as possible. This is usually done during one operation. However, if his condition is severe, two operations may be needed to correct the hypospadias in stages. The operation is usually carried out by a paediatric urologist, a doctor who specialises in identifying and treating conditions of the urinary tract in children.

Your son's foreskin will be used to reconstruct his urethra during the procedure, so it's important that he isn't circumcised before this operation.

Surgery is commonly carried out when your son is 10 to 18 months old. Alternatively it can be done at around four years of age, shortly before your son starts school. However, some parents prefer to leave the operation until their son is old enough to decide for himself.

What are the alternatives to surgery?

If your son has minor glanular hypospadias, he may not need any treatment at all, once he has been assessed by a paediatric urologist - a doctor who specialises in identifying and treating conditions of the urinary tract in children. All other types of hypospadias are usually treated using corrective surgery.

Preparing for your son's operation

Your son's surgeon will explain how to prepare your son for his procedure.

The operation is often a day case, but in some situations your son may need to stay in hospital overnight so that his doctors can monitor his progress afterwards.

The procedure is carried out under general anaesthesia. This means your son will be asleep during the procedure. Typically, your son must not eat or drink for about six hours before a general anaesthetic. Often the operation is planned for the morning, so that your son will only have to miss breakfast.

Before his operation, a nurse will ask you questions about your son's general health. The nurse will also check that your son has not had anything to eat or drink and measure his heart rate and blood pressure. You must tell the nurse if your son has had any allergic or unusual reactions to medicines in the past, or has any history of bleeding problems in the family.

The surgeon will visit your son before the operation. This is a good time to ask any questions.

If you and your son are happy for the operation to proceed, a consent form must be signed. This confirms that you understand the risks, benefits and alternatives to treatment and have given your permission for it to go ahead.

If you have parental responsibility for the child, you will be asked to sign the consent form. This confirms that you understand the risks, benefits and alternatives to treatment and have given your permission for it to go ahead. People with parental responsibility are usually, but not always, the child's birth parents. If your child is old enough, he may wish to sign this form too.

About the operation

The operation usually takes one to two hours, depending on what needs to be done. There are several different techniques for this operation. The technique used will depend on how much correction is needed. Your son's surgeon will explain which method is most suitable for your son. The aim of the operation is to:

create a longer urethra so that his urethral opening is at the tip of his penis
straighten your son's penis by repairing any chordee that is causing his penis to bend
reform the head of your son's penis (glans) into a more normal shape
either create a normal looking foreskin, if possible, or perform a circumcision
create a normal looking scrotum

Your son may not need all these different surgical steps; it will depend on how severe his condition is.

What to expect afterwards

Your son will be monitored for a short while after his operation. He may be groggy, and feel or be sick. He will need to rest on his bed or on your lap until the effects of the general anaesthetic have passed.

He will have a thin, plastic tube (catheter) fitted which allows urine to drain from his bladder, often just into his nappy, and a large dressing covering his penis. Both of these need to stay in place for around a week.

Your nurse will give you advice about caring for your son's dressing before you go home. She may also show you how to put two nappies onto your son, with a hole cut into the inner nappy through which the catheter is passed. This helps keep the dressing dry.

You will be given a follow-up appointment one week after the operation so that your son's dressing and catheter can be removed. You may also be given a further follow-up appointment for three months later.

Recovering from surgery

Your son will feel some discomfort for a few days after the operation. If needed, you can give him over-the-counter painkillers such as paracetamol or ibuprofen syrup (for example, Calpol or Calprofen). Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.

The catheter can sometimes cause your son's bladder to spasm - the muscles in his bladder suddenly tighten and contract. Usually, you will be given anti-spasm medicine for your son before you go home.

It's important to keep your son's dressing as clean and dry as possible. Don't bathe or shower him until his dressing and catheter have been removed. When changing his nappy, use a damp cloth to wipe off any urine or faeces that get on his dressing.

Contact your GP or the hospital if your son complains of severe pain or shows signs that the pain is getting worse. For example, babies and toddlers cry more when they are in pain and are difficult to settle.

What are the risks?

Surgical correction for hypospadias is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects of surgery

These are the unwanted but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic. Common side-effects include pain, swelling and redness around the penis; this usually settles down a few days after his dressing and catheter have been removed.

Complications of surgery

This is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Your son is likely to need a course of antibiotics for a week after the operation.

Specific complications of hypospadias surgical correction are rare, but can include:

narrowing of the new urethra or its opening - it can become too small for your son to pass urine properly
the original urethral opening may open up again so that your son passes urine both through the new and old holes - a further operation may be needed to correct this
sometimes the repair carried out during the operation can come completely undone, and a further operation is necessary to correct it
as your son's penis grows, it may begin to bend as any remaining chordee becomes more obvious

There is a higher risk of complications if your son has had his treatment in two stages instead of one operation.

The exact risks will differ for every person, so we have not included statistics here. Ask your son's surgeon to explain how these risks apply to him.