DrPrashantJain

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Hypospadias Surgery In Delhi at (pedsurgerydelhi)
by Dr. Prashant Jain Hypospadias Surgery in
Delhi
What is hypospadias?
Hypospadias is a birth defect in boys in which
the opening of the urethra is not located at the
tip of the penis. In boys with hypospadias, the
urethra forms abnormally during 8-14 weeks of
pregnancy. The abnormal opening can be anywhere,
from just below the end of the penis to the
scrotum. Understanding the normal penis and
urethra The normal urethra is a tube through
which that urine flows out of the bladder. It
passes through the penis. The opening of the
urethra (meatus) is normally at the end of the
penis, partly covered by the foreskin. What is
the penis like in hypospadias? The main problem
is that the urethra opens on the underside of the
penis instead of at the end of the penis. The
opening can be anywhere from just below the
normal position (mild) to as far back as the base
of the scrotum (severe).
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Hypospadias may also include the following

• A hooded appearance of the foreskin. This is
  because the foreskin does not develop on the
  underside of the penis.
• Tightening of the tissues on the underside of the
  penis (called chordee). This pulls the penis
  down and it cannot fully straighten. This is
  commanly seen in severe hypospedias

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What problems can hypospadias cause? Problems are
likely to occur if hypospadias is left untreated.
The further back the opening of the urethra is,
the more severe the problems are likely to be.

• Passing urine is different to normal. A baby in
  nappies will have no problem. tfowever, when
  older, the urine stream may not be able to be
  directed forward into a urinal. When going to the
  toilet the urine is likely to spray backwards.
  Sitting on a toilet may be needed to pass urine
  without mess.
• Chordee causes bending of the penis. This is more
  noticeable when the penis is erect. Sexual
  intercourse may be difficult or impossible in
  severe
• cases.
• Psychological problems about being different to
  normal are common.

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How common is hypospadias and what causes
it? About 1 in 300 boys are born with some
degree of hypospadias. It seems to be getting
more common. The reason why the penis does not
develop properly is still not clear. The
development of the penis while the baby is
growing in the womb (uterus) is partly dependent
on the male sex hormones such as
testosterone. What is the treatment for
hypospadias? If the hypospadias is mild, with
the opening of the urethra just a little down
from normal and with no bending of the penis, no
treatment may be needed. tfowever, in most cases
an operation is required to correct the
hypospadias. This can usually be done in one
operation. tfowever, if the hypospadias is more
complicated, two operations may be necessary. The
operation is usually done when the child is
around 6-18 months old. The goals of treatment
are
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• For urine to be passed in a forward way.
• For the penis to be straight when erect.
• For the penis to look as normal as possible.
• The position of the opening of the urethra is
  altered. Also, if chordee is present then this
  is corrected to allow the penis to straighten.
  The foreskin is usually used during the
  operation to make the new urethra so it is
  important that a circumcision is not done before
  the corrective surgery is performed.depanding on
  the surgery of hypospedias surgeryes
• The success of the operation and the normality
  that can be achieved depends on the severity of
  the hypospadias done in single as two stage
• What happens after the operation?
• Your son will be brought back to the ward to
  recover. tfe will be able to eat and drink after
  3 hours tfe will have a dressing on his penis and
  a tube draining away the urine. The patients are
  usually kept for 2 days in the hosptial and then
  discharged. The dressing and tube need to stay in
  place for 10 days, then you will need to come
  back to the tfospital to have them removed.
• What are the risks of hypospadias repair?
• All surgery carries a small risk of bleeding
  during or after the operation.
• For about one in ten boys, the original hole
  opens up again, so that your son passes urine
  through two holes. This can occur at any time
  after the operation. If this happens, your son
  will need the operation again.
• Occasionally, the new hole at the tip of the
  penis is too small, so your son
• will need another operation to make the hole
  larger. The drainage tube can irritate the
  inside of the bladder, which is painful. This is
  called bladder spasm. To reduce this, your son
  will be given bladder spasm medicine as well
  as pain relief.

When you get home
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• Your son will go home with the catheter and
  dressing in place. Staff on the ward will give
  you full details of how to care for these at
  home.
• You should encourage, to drink plenty of
  water/fluids.
• Your child may need some pain relief when you get
  home.
• You should not have a bath or shower until after
  the dressing comes off.
• Putting your son in two nappies at a time can
  protect the area from
• accidental knocks.
• Your son should not ride a bicycle or any sit-on
  toy until the area has healed.
• Try to avoid getting the dressing dirty when
  nappy changing. If this happens, dab any faeces
  off with a damp cloth.
• As there is a small risk of infection, your son
  will need to take antibiotics until he returns
  for his outpatient appointment.

Post Op Teaching

• Case of cethetea
• tfow to empty urine bag
• tfow to avoid kinking, twisting, blockage of
  catheter or stent
• May empty straight into nappy
• tfow to tape drainage bag to leg allowing a child
  to be mobile
• Never clamp off catheter
• Child encouraged to increase fluid intake
• Twice daily sponging recommended and loose
  clothing
• No outdoor activity

You should contect

• your child is in a lot of pain and pain relief
  does not seem to help
• there is any oozing from the wound
• the dressing falls off/becomes wet
• the tube stops or reduces the amount of urine
  draining from it or the tube falls out

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What happens next? You will be called for
dressing as per instructions given in discharge
summary. This can be painful, so before hand
make sure that your son has the maximum dose of
pain relief possible but no bladder spasm
medicine. When the dressing has been removed,
the penis will look red and swollen. This is
normal and will settle down within a few days.