Hypospadias Repair: Frequently Asked Questions about Hypospadias Surgery

The answers below are in response to questions that are often asked regarding hypospadias surgery. This is general medical information and not specific medical advice for any individual patient. Please contact your urologist with any specific questions you may have.

What is hypospadias?

Hypospadias is a condition present at birth that affects the penis. There are three common signs of hypospadias:

• The location of the opening through which a boy urinates (urethral meatus) is located at a lower than normal position.
• There can be a bend to the penis. This is typically a downward curve of the penis or forward tilt of the head of the penis (typically called chordee or penile curvature).
• The foreskin can be incompletely formed (typically called Dorsally hooded foreskin).

How common is hypospadias?

Hypospadias occurs fairly frequently and is present in approximately 1 out of every 150 to 300 newborn boys. Mild forms of hypospadias are more common, but pediatric urologists at Children’s Hospital of Philadelphia are experienced in treating both mild hypospadias as well as the less common but more severe forms of hypospadias.

Does my child’s hypospadias need to be fixed?

This depends on many factors including the severity of your child’s hypospadias. The ultimate goal is to achieve optimal voiding (urinating) and sexual function. During your office visit, your physician will discuss your child’s specific form of hypospadias and the potential need for an operation.

Will my child be asleep for hypospadias surgery?

A hypospadias repair is performed while the patient is asleep under general anesthesia. This is the safest way to perform hypospadias surgery. Our anesthesia team uses nerve blocks in the back or the area around the penis to decrease the amount of anesthesia given during the procedure and reduce discomfort as the child awakens from anesthesia. Our anesthesiologists are specialized in treating infants and children of all ages.

How long will hypospadias repair take?

The length of hypospadias surgery varies based on the severity of the hypospadias. Mild hypospadias repair can take 60-120 minutes, whereas more severe forms of hypospadias can take three or more hours to repair.

Why is my child being prescribed pre-operative testosterone before hypospadias repair?

For some patients, we recommend one or two pre-operative injections of testosterone before hypospadias repair. This helps increase the size of the penis prior to hypospadias surgery and helps improve surgical outcomes. If we feel that your child is a candidate for this, we will discuss the timing and details of the injections with you and give you a prescription for the testosterone at the time of your child’s office visit.

What level of pain should my child expect after hypospadias surgery?

Each child’s pain level is different, but typically the most discomfort will occur in the first two to three days after hypospadias repair. We will prescribe pain medication after surgery which typically includes Tylenol and possibly Motrin. Narcotics are typically not prescribed after hypospadias surgery. If a urethral catheter is placed, this can sometimes cause intermittent bladder spasms or discomfort. We will prescribe a medication to help prevent bladder spasms. This medication is called Ditropan® or oxybutynin.

Will my child need antibiotics after hypospadias surgery?

Infections can occur after hypospadias surgery. We typically administer antibiotics when boys are placed under anesthesia. For some hypospadias repairs, we will prescribe an antibiotic while the urethral catheter or stent is in place. More details will be given at the time of surgery.

When can I bathe my child after hypospadias surgery?

Typically, you can bathe your child 24 to 48 hours after hypospadias repair, depending on when the bandage is removed. You should not bathe your child before bandage removal. You can bathe your child while the catheter is in place. Is there any special care for a urethral catheter? The urethral catheter is typically stitched into the head of the penis and does not require any special care. It should drain directly into the diaper and should drain continuously. Parents typically note that their child has a constantly wet diaper. Urethral catheters typically remain in place for five to 14 days after hypospadias surgery. If you notice that the catheter is not draining or that the urethral catheter has come out before the recommended date, please contact our team. Will my child have a bandage on after hypospadias repair? Typically, a dressing (bandage) is applied after hypospadias surgery. After repair, your surgery team will tell you whether a bandage was applied, as well as the type of bandage and when to remove it.

Should I expect bleeding after hypospadias surgery?

There is often a small amount of bleeding onto the bandage or into the diaper in the first few days after hypospadias repair. If you see any active bleeding or dripping of blood, please hold pressure in this area for five to 10 minutes. If the bleeding continues, please contact our team.

What is a normal healing appearance after hypospadias surgery?

Initially, the penis may be bruised, swollen and red in appearance. The skin can also appear dark and sutures will be seen. A few days after hypospadias surgery you may see a white or yellow film on the penis. This is a normal part of the healing process. If there is increasing redness, swelling or drainage from the penis, please contact our team.

How long does it take to heal after hypospadias surgery?

Most boys are discharged from the hospital the same day. The bandage will be removed in three to four days. The stent will be removed in the office five to 14 days after the hypospadias repair procedure. The swelling and bruising is typically present two to three weeks after surgery, and may last longer for some boys. Once the swelling goes away, the penis will have a more normal appearance, although the full healing process will continue for up to one year after the procedure.

Will my child need another surgery?

Most boys will only need one procedure to fix their hypospadias. Some boys will need an additional procedure to repair a complication that can occur after initial surgery. The complications that do occur can be repaired successfully.

How many times will we need to see the doctor after hypospadias repair?

Most boys are seen twice in the first three months after surgery. After that, boys are evaluated at various times depending on how well they are healing. We typically monitor boys as they age, even into puberty. After toilet training, we will check in to ensure they are urinating properly. We usually have them urinate during a follow-up visit to our office to ensure they have a strong urinary stream. These visits are important to monitor for proper healing after surgery. As your child gets older, they may have questions or concerns about their repair, which we can answer on a more personal basis during the office visit.