Children who undergo hypospadias repair are usually discharged from the hospital the same day as the surgery. If you are traveling a long distance, we will help you make arrangements to spend a night in a local hotel so you can be near if questions or problems arise. Then, you can return home rested the next day.
Your child may be discharged with a catheter. If your child wears a diaper, the catheter will drain into his diaper. If your child is older, the catheter will drain into a bag on his leg. Urine may leak around the tube or spurt through the tube. This is common and is not a problem, as long as most of the urine drains through the tube. Excessive leaking might indicate the tube is blocked. If you suspect this, or if the tube comes out, call Pediatric Urology at (415) 353-2200.
The tube may cause bladder spasms while your child is sleeping. He may arch his back, bring his knees up to his chest and urine may squirt through or around the tube. Spasms aren't harmful, but may be uncomfortable. A spot or two of blood on the diaper is normal. Don't apply powder or ointments to the genital area. If your child has loose bowel movements and soils his surgical dressing, clean it gently with soapy water and a washcloth, away from his penis.
Children who don't have a catheter may complain of discomfort or cry while urinating through the repaired area for one or two days.
If your child has a catheter, you will be given an antibiotic upon discharge from the hospital. Continue to give the antibiotic for several days after the removal of the catheter. Tylenol, with or without codeine, may be given for discomfort. If your son has a tube in his penis, Ditropan may help bladder spasms until the tube is removed. Stop administering the Ditropan the night before your appointment to have the tube removed. Ditropan may cause a dry mouth and flushing of the face. Encourage your child to drink lots of fluids.
Most children will be given a nerve block during surgery to reduce pain. This block will wear off in four to six hours. Sometimes, children experience more discomfort than usual for 15 to 20 minutes when the block wears off. To help prevent this, give Tylenol or Tylenol with codeine about three-and-a-half to four hours after the surgery, even if your son is comfortable.
Some children may change their sleep patterns — they may be sleepy during the day and up at night. This is temporary, and your child most likely will resume his usual habits shortly.
Your son will go home with a "dressing" or covering consisting of a clear plastic over gauze, or plain gauze taped around his penis. It may become soiled and loose from urine and stool. Don't remove the soiled dressing unless there is stool underneath the plastic dressing, in contact with the gauze. If the dressing is covered with stool, clean with soapy water, wiping toward the rectum and away from your child's penis.
Remove the dressing two days after your son's surgery. This can be done easily in the bath. If your son has a urethral catheter, be mindful of the tube. Expect some swelling and discoloration of the penis after the surgery, which will resolve in time. Some oozing from the penis resulting in spotting on the dressings, diaper or underpants is normal.
Sponge-bathe your child until the dressing is removed. You can give your son tub baths when the dressing falls off or two days after the surgery, whichever occurs first. Your child can take a tub bath even while the catheter is in. When you resume regular bathing, use tepid water without soap. Don't scrub the area and don't directly wash the penis; just allow the water to soak the area. Gently pat the area dry with a clean towel.
If your son wears diapers, use two diapers for added protection and cushioning. If he is going home with a tube in his penis or bladder, your nurse will show you how to arrange the double diapers. The inner diaper is for his bowel movements and the outer diaper will absorb his urine. If you notice a dry diaper, call our office at (415) 353-2200. A spot or two of blood on the diaper is normal.
Avoid applying powder or ointments to your son's genital area. Some parents apply antibiotic ointment, such as bacitracin, in the outer diaper to prevent the child's penis from sticking to the diaper. This isn't necessary, but doesn't harm the repair. If your child has a loose bowel movement and soils his surgical dressing, clean it with soapy water and a washcloth, gently wiping away from his penis. Don't scrub the soiled area.
Your child can resume a normal diet at home. Encourage fluids — for example, ice pops, juice, soup — to keep your son's urine clean. Some children may have nausea or vomiting from the anesthesia, but most will be fine. Gradually, your son's appetite will return to normal and he can have any food he likes.
Please encourage quiet play. Watching television, playing board games or walking your infant in a stroller are encouraged. Avoid contact sports, gym, sandboxes, bicycles and straddling toys. Older children should avoid strenuous activities such as wrestling, gymnastics and bike riding for three weeks. There is no need to restrict the activities of infants, except for swimming and rigorous sandbox play.
Please call the Pediatric Urology office at (415) 353-2200 to make an appointment to have his catheter removed about one week after the surgery, unless you are instructed otherwise. If you live far away, your local urologist, pediatrician or even yourself, may remove the tube at the appropriate time.
When the tube is removed, remember to observe the urinary stream. You may notice some spraying of urine; this is normal. If you notice a thinning of your son's stream, call Pediatric Urology at (415) 353-2200.
If your child is toilet trained, we will need to observe him urinating while standing up at his next office visit. Encourage him to drink on his way to the office so that he will be ready to urinate when you arrive.
A follow-up visit should be scheduled for four weeks after the tube is removed. Older boys may be frightened about coming back. Do your best to reassure them and stay calm.
Questions and Concerns
You may have some additional questions once you leave the office after the surgery is performed. Please feel free to write them down and bring them with you the next time you visit the doctor.
Please contact Pediatric Urology at (415) 353-2200 if you are concerned with your child's progress after surgery, or if your child exhibits any of the following:
- Temperature greater than 101° F
- Excessive bleeding (some spotting or blood stains on the dressing is normal)
- Extreme irritability
- Excessive pain
- Increasing redness of the penis
- Disinterest in eating and drinking (particularly after 24 hours)
- Continuous vomiting
- Change in urination
- Difficulty urinating (pushing when he urinates)