• Reference Number: HEY1264/2021
• Departments: Paediatrics
• Last Updated: 30 November 2021

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your child’s healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of your child’s healthcare team.

What is hypospadias and what causes it?

Hypospadias is present in 1 in 250 boys from birth and it affects their penis.  It has up to 3 characteristics:

1. The hole that urine passes through is not in the correct place
2. The foreskin is absent at the front of the penis, with excess at the back
3. The penis may be bent when stiff. This is known as chordee

Hypospadias can vary in severity.  For example, the urine hole maybe only a small distance from the tip of the penis, whereas in others it may be at the base of the scrotum.

The cause of hypospadias is unknown but it is unlikely to be caused by anything that has happened during pregnancy.  Hypospadias can be associated with other conditions such as hernias and undescended testes.

Most children are diagnosed at routine baby checks and are referred to a paediatric urologist who will assess the severity and plan treatment.  IT IS IMPORTANT THAT CIRCUMCISION DOES NOT OCCUR as the foreskin is sometimes used for repair. 

Are there any alternatives to an operation?

Hypospadias is not life threatening.  It can mean that, as your son gets older, he might not be able to urinate whilst standing and may not have an adequate erection making sex difficult.  There is no alternative to an operation for treatment of hypospadias, although in some of the milder forms parents may elect to wait until their child can be part of the decision-making process. 

What happens in the operation?

The operation is performed under a general anaesthetic and takes between 1 – 3 hours, depending on the severity of the hypospadias. The aim of the operation is to create a penis that appears more normal.

To do this the surgeon will:

1. Straighten the penis
2. Move the urine hole to the tip of the penis
3. Remove the excess foreskin (circumcision) or reconstruct the foreskin where possible

Sometimes the above can be achieved in one operation but in some cases two operations may be needed.  The surgeon uses the tissues of the penis to create a urine tube, where it is absent.  If there is not enough good quality tissue, then a 2-stage procedure will be necessary.

During this operation a graft of tissue, taken from the foreskin or inside of the mouth, would be placed on the penis.  After approximately 6 months this “new tissue” will be used to form a new tube.  Sometimes other graft material is used to support the repair, but the surgeon will discuss this with you at the time. 

What are the risks?

All operations have a risk of bleeding and infection.  Your child will be given antibiotics to help prevent this but occasionally this can cause the wound or graft to open.  A urinary catheter or tube is placed during the initial recovery to aid your child passing urine and this can cause bladder spasms, for which your child will receive medication.  In about 1 in15 boys the original hole can open again; this is called a “fistula” and it may appear that your son is urinating through two holes. This can happen at any point after the operation and will require a further procedure. Sometimes the new hole created at the tip of the penis can become narrowed or “stenosed” and again this would require a further, smaller procedure to widen the opening. 

How do I look after my child after?

Once your child recovers from the anaesthetic he will be able to eat and drink soon afterwards. If your child is still in nappies he will come back from theatre wearing two.  This is what we call double-nappying; the inner nappy collects stool and has a hole cut out at the front.  Through this hole his penis will poke through wrapped in a dressing.  There will be a thin plastic tube “stent” dripping urine into an outer, second nappy.  This tube is passing through the urethra into the bladder.  If your child is toilet trained he will have a normal urethral catheter.

As mentioned above, the urine tubes can cause bladder spasms which can, in turn, cause tummy pain and discomfort around the penis or bottom area.  Your child will be given medication for this.  We would anticipate that your child will be able to go home on the day of surgery.

Your child will be uncomfortable for a day or two.  You can pick them up, cuddle them and treat them normally immediately after the operation. The dressing and drainage tube stay in for at least a week; nursing staff will explain how to look after these before going home.  Baths and showers should be avoided until after everything is removed.  The dressing will smell by the end of the week, this is normal.  If the dressing gets dirty during nappy changes, gently dab off stool with a damp cloth. 

Will my child be followed up?

Should your child have severe pain which is not improved by medication, oozing from the wound, the dressing falls off, the amount of urine draining reduces or stops or the tube falls out, please contact the number below.

Your child will need to come back after approximately one week for dressing removal.  If your child has had a single operation the dressing will be removed on the ward.  If your child has had the first of two operations the dressing will be removed under a further general anaesthetic for the surgeon to assess the graft.  This can be uncomfortable so give your son the full pain relief medication in the morning, except the bladder spasm medication.  When the dressing has been removed the penis will look red, swollen and bruised. This is normal and should settle, if your child does experience problems such as increased pain, the wound becomes increasingly red, hot and swollen, there is oozing from wound, a high temperature or problems passing urine you can either visit your local doctor or get in contact with us through the main hospital switchboard (01482) 875875 and ask to be put through to the ward where your child was cared for or the secretary of the surgeon who did your operation. Please be aware that there is a limit to what staff will be able to advise without seeing your child. If your child is unwell and you need help as an emergency, you should take them to your nearest Emergency Department.

Your child will need to be seen in clinic in approximately 6 months from the date of the procedure, at which time an evaluation of the flow of urine may be performed if required. 

Further Help and Advice

Should you need any further help or advice please telephone:

Acorn Ward, Women and Children’s Hospital, HRI

Telephone (01482) 382609 / 382679.

Or contact the Paediatric Community Team:

Paediatric Community Team

Telephone (01482) 344077.