Hypospadias

Hypospadias occurs when the penis develops abnormally and is usually identified at birth. The condition affects approximately one in 250 boys and may include the following:

• the urethra opens on the underside of the penis
• the foreskin is only at the back of the penis (dorsal hood)
• the penis may not be straight (this is called a chordee).

The operation

Surgery is usually needed to help pass urine normally and make the penis more ‘normal’ looking. This operation is called a hypospadias repair or urethroplasty and is generally conducted between the ages of six and 18 months.

The operations will focus on correcting areas such as:

• moving the urethra hole to the tip of the penis
• straightening the penis shaft
• removing excess foreskin or reconstructing the foreskin ( if required).

The repair may be done in one or two stages and many repairs can be done as day surgery. A successful repair will last for a child’s lifetime and adjust with growth however, further surgeries may be required.

It’s not advisable to circumcise your child as the foreskin is required during the operation.

After the operation

The doctor will inform you about your child’s progress once the operation is completed. When your son arrives back in the ward he may have a drip running into one of the veins in his arm to provide him with fluids. However, this can depend on the doctor’s preference.

Your son may also have a catheter, which is a small tube inserted into the penis or
abdomen that will allow urine to drain out into a collection bag or a nappy. This diverts the urine to allow healing to take place.

After a single stage or a second stage hypospadias repair the catheter remains in for approximately five to 12 days (depending on your doctor’s preference) and is then removed.

A dressing is wrapped around the penis and is removed between two and seven days after your son’s operation.

These times can vary depending on the type of repair required.

Pain relief

Pain relief such as paracetamol or Ibuprofen (Nurofen©) may be prescribed after the operation for at least the first two days. Antibiotics may also be prescribed.

Your anaesthesist, surgeon, pharmacist and/or nursing staff will discuss the suitability of these medications for your child before you go home.

If your child has bleeding problems or asthma, it is recommended that you consult a doctor before you give them Ibuprofen (Nurofen©). Do NOT give Asprin to your child.

When to eat and drink again

Your child can drink about two hours after the operation. Once tolerating fluids your child can have a normal diet.

Before going home

Before going home your nurse will teach you how to manage the catheter and care for your son. The doctor will give you an appointment to return to 3B Outpatient department for removal of the dressing and catheter.

It’s recommended that you give your son pain relief prior to arrival at the hospital. There may be some discomfort during the procedure but a general anaesthetic is not required.

It is also important to keep the dressing dry. If it does become wet, phone the ward for advice.

Note: Babies will be discharged in ‘double nappies’ and you will be shown this method. Obviously following a bowel motion the dressing may become soiled. It is necessary to wipe it clean as best you can. By the time the dressing is removed it may be quite ‘smelly’.

Remember, if you have any concerns you can phone the ward at any time.

Care at home

It is important to give your child plenty of fluids to drink to keep the catheter draining well. The extra drinks also help as some children become a little constipated and have difficulty passing their bowel motions.

Follow-up visits

When you bring your child back for the removal of the dressing and catheter, don’t forget to give pain relief prior to leaving home. The doctor will normally remove the dressing and give you further instructions about coming back for removal of the catheter.

After the catheter is removed, some vaseline may be applied to the centre of the nappy or the tip of the penis to prevent irritation from clothing or nappies.

When to seek help

See your GP if your child has any common symptoms.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Department of Paediatric Surgery and Urology, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS179. Reviewed: December 2016.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.