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Hypospadias Repair: Taking Care of Your Child at Home After the Operation

Your child has had a hypospadias repair operation. This procedure moves the opening of the penis to the right place so your child can pee more easily.

Hypospadias
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Usually, the opening of the urethra, or meatus, is at the tip of the penis. In children with hypospadias the opening of the urethra can be located at various positions along the underside of the penis. The foreskin may not completely close over the head of the penis. The location of the urethral opening can range from just below the usual position on the glans to between or underneath the scrotum.

After a hypospadias operation, most children go home the same day. Here is some information you can use to help your child heal at home.

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 his operation, give him acetaminophen (Tylenol or Tempra) or ibuprofen (Advil or Motrin). Always read the label on the medicine bottle and follow the instructions.

Do not give your child ASA (acetylsalicylic acid or Aspirin).

If your child has more severe pain or if these medications do not help, your child 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.

A stent: caring for the tube inside your child's penis

Your child will have a plastic tube called a stent in his urethra. This stent keeps the urethra open so that it heals properly. The urethra is the tube inside the penis that carries urine out of the bladder.

The stent is held in place with a stitch. You will have to bring your child back to the urology clinic to have the stitch and the stent removed. This will happen about 1 week to 10 days after the operation.

Sometimes, the stent falls out at home. If this happens, call the urology clinic at the hospital.

Some children may need a catheter

Depending on how complex the hypospadias repair operation was, your child may have a catheter instead of, or as well as, a stent. A catheter is a tiny plastic tube that drains urine out of the body.

Foley catheter

Some children have what is called a Foley catheter placed in the urethra instead of the stent. If this is the case, it will likely stay in for up to 2 weeks.

Suprapubic catheter

More rarely, a child may have a suprapubic catheter. This catheter is surgically placed between the bladder and the outside of the belly. It drains urine to an attached bag. A suprapubic catheter is removed about 1 week after either the Foley catheter or stent has been removed from the urethra. If your child has a suprapubic catheter, you will be given more information on how to care for it.

To learn more, please read "Urinary Catheter: Care at Home."

Soaking off the bandage after the operation

Your child will come home with a bandage on his penis. Within 2 days (48 hours) of coming home, start giving your child warm baths. You can bathe your child 3 or 4 times a day. The bandage should start to come off on its own in the bath, if not, you will need to take it off. The bandage should be fully removed within 1 to 2 days (24 to 48 hours) after the surgery. If you have problems getting the bandage off, call the urology clinic.

Every time you bathe your child, let his penis dry by itself. Then put an antibacterial cream such as Polysporin on the whole area.

If you can, double diaper

If your child's stent or catheter is long enough, you can double diaper him. This means he will wear 2 diapers, one over the other. First, diaper him as always but tape the tube to the outside of the diaper. Then put the second diaper over top of the first 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 him as you normally would.

There may be a little bleeding

You may see a little bleeding from your child's stitches. This is more likely to happen if your child bumps or bangs himself. A little bleeding is normal. You may see a small amount of blood when you change your child's diaper in the first few days.

If there is a lot of bright red active bleeding when you get home from the hospital, press firmly with your hand on your child's penis right away. Keep pressing for 15 minutes and call the urology clinic.

Eating and drinking after the operation

Your child needs to have plenty of liquids after the operation. He should drink more than he normally would when he gets home from the hospital.

Codeine and other medicines may cause your child to have constipation. Constipation means problems having a bowel movement (poo). It is important to avoid this. If your child becomes constipated, he may push too hard when he has a bowel movement. This can cause pain. Your child may need stool softeners and glycerin suppositories if he is having constipation. If you are unsure of what product(s) to use, please talk to the pharmacist or call the urology clinic and speak to a nurse.

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.

Your child's nurse will talk to you about other foods that have lots of fibre.

To learn more, please read "Higher Fibre Diet."

Your child's activity

Your child should wear loose clothing or diapers. He should participate in quiet activity and avoid toys he has to straddle for the first several weeks after surgery. Once your child is feeling better, he can return to activity and day care or school as usual.

Bladder spasms

Having a catheter in the bladder can sometimes cause spasms. These spasms may cause pee to leak from the penis. Spasms are also uncomfortable. If your child cannot cope with his bladder spasms, call the urology clinic. Medication is available to help prevent 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.

If you have urgent questions about your child's care at home, call the urology clinic.

Follow-up appointments

Your child will need 2 follow-up appointments.

Removing the stent

About a week after the operation, you will bring your child to the clinic to have the stent removed by the urology clinic nurse.

Checking the penis and how well your child is peeing

About 3 months after his operation, you will bring your child back to the clinic for a follow-up appointment. If your child is toilet-trained, he will have a flow rate test to measure how well he is peeing. If you can, make sure your child drinks lots of fluids before coming to the appointment.

Key points

  • After a hypospadias operation, most boys go home the same day.
  • Your child may have some pain and fever for a day or two after the operation.
  • Your child will have small tube coming out of his penis. Some children may also have a catheter.
  • Your child's bandage may soak off in the bathtub. If not, you need to take it off within 2 days (48 hours) after surgery.
  • Your child will need 2 follow-up appointments.

Cathy Daniels, RN, MN

11/17/2009

At SickKids:

If your child has a high fever, uncontrolled pain or bladder spasms, or there is no pee coming from the stent, please call urology on call through locating at 416-813-6661 and ask to speak to a nurse.





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