HYPOSPADIAS REPAIR AFTERCARE

The diagnosis of hypospadias in boys is often made at the time of delivery during the newborn examination. The condition may also be diagnosed before birth by ultrasound; according to a group of Israeli researchers, ultrasound images of severe hypospadias resemble the outline of a tulip flower. Ultrasound is also used prior to surgical repair to check for other abnormalities, as about 18% of boys with hypospadias also have cryptorchidism (undescended testicles), inguinal hernia, or defects of the upper urinary tract. Hypospadias in girls may not be discovered for several months after birth because of the difficulty of examining the vagina in newborn females.

Preparation
Male infants with hypospadias should not be circumcised as the foreskin may be needed for tissue grafting during repair of the hypospadias.

Some surgeons prescribe small doses of male hormones to be given to the child in advance to increase the size of the penis and improve blood supply to the area. The child may also be given a mild sedative immediately before surgery to minimize memories of the procedure.

Aftercare
Short-term aftercare
Many anesthesiologists provide a penile nerve block to minimize the child’s postoperative discomfort. Dressings are left in place for about four days. The surgeon places a stent, which is a short plastic tube held in place  with temporary stitches, or a catheter to keep the urethra open. The patient is usually given a course of antibiotics to reduce the risk of infection until the dressings and the stent or catheter are removed, usually 10–14 days after surgery. The child should be encouraged to drink plenty of fluids after returning home in order to maintain an adequate urinary output. Periodic follow-up tests of adequate  urinary flow are typically scheduled for three weeks, three months, and 12 months after surgery.

Long-term aftercare
Boys who have had any type of hypospadias repair should be followed through adolescence to exclude the possibility of chronic inflammation or scarring of the urethra. In some cases, psychological counseling may also be necessary.

Risks
In addition to the risks of bleeding and infection that are common to all operations under general anesthesia, there are some risks specific to hypospadias repair:
• Wound dehiscence. Dehiscence means that the incision splits apart or reopens. It is treated by a follow-up operation.

• Bladder spasms. These are a reaction to the presence of a urinary catheter, and are treated by giving medications to relax the bladder muscles.

• Fistula formation. A fistula is an abnormal opening that forms between the reconstructed urethra and the skin.

Most fistulae that form after hypospadias surgery close by themselves within a few months. The remainder can be closed surgically.
• Recurrent chordee. This complication requires another operation to remove excess fibrous tissue.
• Urethral stenosis. Narrowing of the urethral opening after surgery is treated by dilating the meatus with urethral probes.

Normal results
Hypospadias repair in both boys and girls has a high rate of long-term success. In almost all cases, the affected children are able to have normal sexual intercourse as adults, and almost all are able to have children.

Morbidity and mortality rates
Surgical repair of hypospadias has a fairly high short-term complication rate:
• leakage of urine from the area around the urethral meatus: 3–9%
• formation of a fistula: 0.6–23% for one-stage procedures; 2–37% for two-stage procedures
• urethral stenosis: 8.5%
• persistent chordee: less than 1%Alternatives

There are no medical treatments for hypospadias as of 2003. The only alternative to surgery in childhood is postponement until the child is old enough to decide for himself (or herself) about genital surgery.

See also Orchiectomy.