Your child has had hypospadias surgery. This procedure is done to ensure your child has the ability to urinate (pee) in a single straight stream and have natural penetrative sexual function.
After a hypospadias operation, most children go home the same day. The following article describes the phases of care at home that must be followed after hypospadias surgery.
After the surgery
Before your child is discharged from the recovery room (Post Anesthesia Care Unit), the nurses will provide discharge instructions with information regarding your child’s activities, diet, pain management, and follow-up appointments.
The first night
Eating and drinking after the operation
Your child needs to have plenty of liquids after the operation. Give your child clear fluids (water/juices) for the first two hours after surgery to help prevent vomiting. Your child may eat and drink as usual as soon as they wake up from the anaesthetic.
Your child should be encouraged to drink more than they normally would when they get home from the hospital.
Pain medication
Even if they are comfortable, it is important to give your child acetaminophen and ibuprofen continuously for the first 48 hours as prescribed. This prevents pain from occurring. Treating new pain is often more difficult. After 48 hours, use pain medication as needed.
Bleeding
You may see a little bleeding at the incision sites. A little blood spotting on the diaper or underwear is normal in the first few days after the operation.
At any time, if there is a lot of bright red blood or a large amount of clotted blood in the diaper or underwear, or your child’s penis is actively bleeding, press firmly with your hand on their penis right away. Keep pressing for 15 minutes and call the urology clinic, or take your child to the nearest emergency department.
Urine catheter: Ensuring proper drainage, catheter care and removal
Your child may have a soft silicone tube called a catheter in their urethra at the end of the surgery. This catheter helps urine to drain from the bladder in the days following the surgery and helps the urethra heal. It is important to make sure that the catheter is draining freely into the diaper or urine drainage bag and that there are no kinks in the tube.
The catheter is often held in place with a stitch, but may also be taped in place. If there is a stitch holding the catheter in place, you will be instructed to bring your child back to the urology clinic to have it removed one to two weeks after the surgery. This can also be done by your child's primary health-care provider if you are unable to return to the clinic or live a significant distance from the clinic.
Sometimes, despite the stitches, the catheter falls out at home. This is not an emergency, as long as your child is able to pee normally. If they are unable to pee, please take them to the hospital emergency department for assessment. If the catheter is dangling from the penis by the stitch, please contact the urology nurse or your primary care provider to arrange a time to have the stitch removed.
Bladder spasms
Having a catheter in the bladder can sometimes cause spasms. These spasms may cause pee to leak from the penis around the catheter. Spasms are also uncomfortable. If your child is experiencing pain, they may arch their back with irritability and wake up from a sound sleep with a strong urge to pee. Use the medications you have received to help with bladder spasms. Keeping your child’s catheter draining freely will also help. Your nurse will discuss with you the best way to treat bladder spasms at home.
The first 30 days
You will actively engage with the urology team in the first 30 days by answering daily questions (via a provided link) about your child’s post surgery health to make sure that your child does not have an infection, is not experiencing significant bleeding or pain, and can empty their bladder. During this time, you will also be instructed to take daily post-operative pictures to be submitted through your child’s patient health chart.
Caring for your child’s fever or pain
As with almost any operation, many children get a fever on the first day after the procedure. It is also normal for children to have some pain in the first few days after an operation.
If your child has a fever or mild pain after the operation, give them acetaminophen or ibuprofen. Always read the label on the medicine bottle and follow the instructions. If this is pain related to bladder spasms, you will be provided with a prescription medication called oxybutynin.
Do not give your child acetylsalicylic acid (ASA).
If your child has more severe pain or if these medications do not help, they may also be prescribed morphine. Make sure you read the label on the bottles of medicine to find out how often you should give your child each medicine. Follow these instructions exactly. If you have concerns, talk to your pharmacist or to the nurse at the urology clinic.
Bathing
You may bathe your child as usual 48 hours after surgery. If there is any soiling or obvious need for a bath before the 48 hours, you may proceed with giving your child a bath. Once you begin bathing your child again, it is recommended that you let them soak in warm water 5-10 minutes at a time, twice a day, without using any soap. Make sure that your child’s penis is under the water in the bath. It is okay to let the catheter tube soak in the water as well.
Please bathe your child according to your surgeon’s instructions. After each bath, you may pat your child dry. You should apply Vaseline or Polysporin, as per your surgeon’s instructions, to the penis after each bath.
Removing the dressings after the operation
If your child underwent a first-stage hypospadias repair with a graft, the dressing instructions below will not apply to them. You will be given instructions to return to the clinic nurse to have the dressings changed and the catheter removed.
Your child may have a beige dressing (called Coban) wrapped around their penis at the end of the surgery. You will be asked to unwrap this the day after the surgery at home. The edge of the dressing will be marked. If there is a stitch to keep the dressing in place, this will need to be removed at the hospital, where the Coban will be removed at the same time.
There is usually a plastic dressing that looks like cling-film covering the penis. This dressing will loosen as it gets exposed to water during bathing and detach with time. If it is not yet detached when your child comes for their catheter removal, the nurse may remove it then. You do not need to try to pull this dressing off.
Beneath the plastic film, there may be some surgical glue that looks a bit like nail varnish. This will peel off on its own in one to two weeks.
Double diapers
If your child is still in diapers, it may not be necessary for them to ‘double diaper’ after hypospadias surgery. However, if your child’s catheter is long enough, you can double diaper them. This means they will wear two diapers, one over the other. First, diaper your child as usual but leave the end of the catheter hanging out of the diaper. Then, put the second diaper over top of the first, with the end of the catheter sandwiched between the two, so that the pee can drip into the second diaper.
If the tube coming out of your child’s penis is not long enough to do this, just diaper them as you normally would.
Apply Polysporin antibiotic ointment to the operated areas of the penis at each diaper change for the first week. Afterward, switch to Vaseline at each diaper or underwear application. Your child should be cleaned in the usual fashion after passing stool, wiping away from the penis.
Bruising
You can expect to see swelling and bruising within the first two weeks. This should improve over the first month and may take up to six to eight weeks to completely resolve.
Constipation
Constipation means problems having a bowel movement (poo). It is important to avoid this. Constipation is common after being given anaesthetic during surgery. If your child becomes constipated, they may push too hard when they have a bowel movement. This can cause pain while peeing and straining may prevent the surgery incision from healing properly. Your child may need stool softeners, such as PEG 3350 (Restoralax), to help them have regular bowel movements in the months after the surgery. Glycerine suppositories may also be useful, in addition to stool softeners, on direction of the urology team.
Morphine, oxybutynin and other medicines may cause your child to become constipated.
Drinking lots of water will help. Your child should also eat foods that have lots of fibre. These include whole grain breads and fresh fruits. These foods will prevent constipation while your child is less active and recovering.
To learn more, please read Higher fibre diet.
Normal healing versus signs of infection
Normal healing after hypospadias surgery is noted by a white/yellow scab or film around the penis or surgery site and is not a sign of infection. This usually disappears after a few days. Redness, where the skin looks raw, and bruising are also common and usually only involve the area immediately around the surgery site.
Signs of infection:
- High fever (greater than 38.5°C) that is not controlled by medications
- Spreading heat, swelling and redness away from the surgical site
- Greenish, bad-smelling discharge around the surgery area
- Uncontrolled pain
- Excessive vomiting or inability to take in liquid or food
If any of the symptoms listed above occur, contact the urology clinic or go to the closest emergency department.
Your child’s activity
Your child should wear supportive underwear or diapers. Your child can be placed in a car seat or stroller as usual.
Once your child is feeling better, they can return to quiet activity and day care or school. They may play as usual, but should avoid putting pressure on the penis area, like using straddle toys (e.g., bicycles, tricycles, rocking horses) for the first month after surgery. They should also avoid activities for the first month that can potentially expose the incision site to dirt, such as going to the beach or playing in a sandbox.
Your child may swim once the catheter tube has been removed. They should avoid public pools and lakes for the first few months after surgery.
After the first 30 days
About three to six months after the operation, you will bring your child back to the clinic for a follow-up appointment to see how things are going. No earlier checkup is routinely required. Your surgeon may also arrange another future follow-up visit after that.
When to see a doctor
Call your child's doctor, the urology clinic or go to the nearest emergency department right away if your child shows any of the following symptoms:
- Unable to urinate (pee)
- There is a lot of bright red blood or a large amount of clotted blood in their diaper, or your child’s penis is actively bleeding
- High fever (greater than 38.5°C) that is not controlled by medications
- Spreading heat, swelling and redness away from the surgical site
- Greenish, bad-smelling discharge around the surgery area
- Uncontrolled pain
- Excessive vomiting or inability to take in liquid or food
At SickKids
You will be issued with a printed After Visit Summary after your child’s surgery. Read this document carefully, as there may be unique post-operative monitoring instructions specific to your child in addition to the information discussed above.
If your child has a high fever, uncontrolled pain, or there is no pee coming from the catheter, please contact the urology clinic at SickKids or your child’s regular health-care provider if you live far away from SickKids. At any time, you can visit your local emergency department if you are unable to reach the clinic nurse after hours and on weekends.
Daily check-in post-op questions
SickKids clinic staff will send you a brief survey of questions about your child’s well-being on the first day after surgery. Please make sure to complete the survey as soon as you receive the survey link. This will then automate the survey process, and you will receive the same survey for the next 29 days. If you answer “yes” to any of the questions, the clinic staff will be alerted immediately and will contact you. For what constitutes an emergency, please refer back to your After Visit Summary.
Healing and photos
So that the hypospadias team may observe your child’s healing, you will need to send photos of your child’s healing progress every day for the first 30 days after surgery. Your child’s health-care team will provide instructions on how to take pictures and send them to the hospital securely.
Resources
Please see the SickKids urology website for more information about the hypospadias clinic at SickKids.