What is involved in hypospadias surgery?
Hypospadias surgery is done to ensure your child has the ability to urinate (pee) in a single straight stream and have natural penetrative sexual function. It involves the following steps:
- Making the penis straighter (correcting or minimizing the curvature)
- Building a urethra (tube for urine and semen) so that the urethra opening is closer to or at the tip of the penis
- Using the foreskin tissue to help build, close and protect the urethra
Almost all hypospadias surgeries are completed as day surgeries. Your child will go home with you on the same day. If your child has a more severe form of hypospadias, they may require several surgeries.
Hypospadias surgery requires a general anesthetic. Your child will be sleeping during surgery and will not feel any pain.
What are the possible risks of surgery?
The risks of hypospadias surgery include:
- Bleeding
- Infection
- Over-healing or scarring that makes the opening or the inner tube of the urethra too tight
- New pain while urinating, urinary tract infection, or difficulty emptying the bladder
- Poor healing that results in a leak called a fistula, or complete breakdown of the tissues (dehiscence)
With proximal hypospadias, these risks are usually higher than with distal hypospadias.
Giving consent before the procedure
Before the procedure, the surgeon will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks, and will help you weigh any benefits against them. It is important that you understand all of these potential risks and benefits of the surgery and that all of your questions are answered.
If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. In Ontario, there is no legal age of consent for health care which means that, for some decisions, your child may be capable of consenting when they are 11, 12 or 13 years old. Any person who is capable has the right to make their own decisions about their health. In health care, being capable means that you understand the information about the decision you are going to make, and you appreciate what the consequences of the decision mean to you as a person. The procedure will not be done unless you or your child give consent.
Visit the AboutKidsHealth Teen site for more information about your child’s rights in a health-care setting.
Surgical booking and preoperative assessment
At Sick Kids, if your child is to have surgery, the urology surgical booking office will call you with the date and time of your child’s surgery. They will also provide instructions by email on how to set up access to your child’s health chart, how to take pictures in preparation for surgery, and how to monitor your child after their operation.
Before surgery, a screening appointment with the pre-anaesthesia clinic will be conducted over the phone or in person depending on the health status of your child.
How to prepare your child for the procedure
Before surgery, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of their procedure. If your child starts to feel unwell or has a fever within two days before the surgery, let your doctor know. Your child’s procedure may need to be rebooked.
Fasting guidelines
It is very important to understand and follow the fasting guidelines before surgery, based on the start time of your child’s surgery. You will be asked to answer some questions about the feeding instructions at least two days before your child's surgery to ensure you understand them. If a mistake occurs in fasting before surgery, the surgery will be cancelled and rescheduled. This is an extremely important safety measure.
- Your child’s stomach must be empty before sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your child’s surgeon to make a plan.
- Ask your child’s surgeon if they can take their regular medicine before the procedure.
- Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by their surgeon.
Why must my child fast before surgery?
Stopping eating and drinking before a planned surgery is designed to make sure your child’s stomach is empty when the anaesthesia is given. Otherwise, food or liquid may enter your child’s lungs during the operation, which can severely damage them. Your child should follow the fasting guidelines the night before surgery and on the day of surgery. Again, if you do not follow these guidelines, your child’s surgery will be cancelled.
Pre-operative testosterone for proximal hypospadias
In many cases of proximal hypospadias, your surgeon will prescribe testosterone injections to help with growth of the penis before surgery, which will help during the procedure. These are single injections, which will be given to your child by your pediatrician or family doctor three months, two months, and one month before the surgical date. You must wait to receive a surgical date before starting the injections.
Day of surgery
On the day of surgery, please bring all of you child’s medications, OR bring a complete list of your child’s medications, OR bring photos of your child’s medication vials using your mobile device.
Arrival at the hospital and registration
Arrive at the hospital two to three hours before your child’s surgery and check in at the pre-operative surgery registration desk.
Once you are checked in, your child will be dressed in a hospital gown and assessed by a nurse. Your child may have an intravenous started. You will also be able to speak to the surgeon who will be performing the surgery and the anaesthetist or nurse who will be giving your child medication to make them comfortable during the procedure.
During the surgery, you will be asked to wait in the surgical waiting area.
In the operating room
Children are given medicine prior to treatments/procedures that may be frightening, uncomfortable or painful. This includes sedation and/or general anaesthesia. The type of medicine that your child will have for the procedure will depend on your child’s condition.
The purpose of your child’s surgery is to extend the length of the urethra. Your child’s surgeon may use a small piece foreskin or tissue from another site to increase the length of the tube. A catheter may be placed in the urethra to hold its new shape.
Your child may require more than one surgery, depending on the severity of their hypospadias.
What happens immediately after my child leaves the operating room?
Your child will be moved to a recovery room where they will remain for one to two hours, depending on their status. A member of the surgical team will come and speak to you in the surgical waiting area after the procedure. When the recovery room is ready, you will be escorted to reunite with your child. When your child is deemed ready by the recovery room staff, your child will be discharged home.
In some complex cases, your child will be admitted to the hospital overnight for observation.
Caring for your child at home
Once you arrive home, it is important that you follow all of the steps for caring for your child after they have had hypospadias surgery.
Please click this link: Hypospadias surgery: Taking care of your child at home after the operation.
At SickKids
If you have any questions about your child’s hypospadias, please use MyChart messaging to contact the urology clinic nurses. If you do not receive a response within 48 hours, please use the following contact information:
Urology clinic: 416-813-6661
E-mail: urology.nurses@sickkids.ca