Hypospadias Specialty Center POSTOPERATIVE INSTRUCTIONS
Hypospadias 1st Stage Graft Repairs
Most patients recover from hypospadias surgery without significant problems or complications. However, the penis may show swelling and bruising when the bandages come off, with these sometimes extending down around the testicles. This swelling and bruising gradually improves over the first 6 weeks, although it may take a few months before the skin appears totally normal.
There is a rolled Vaseline gauze lying against the graft and held in place by 3 or so blue stitches tied over the roll. Then there is a regular gauze covering the penis held in place by a plastic bandage.
The outer gauze may turn red from normal oozing of blood after the operation, which should not concern you. Please refer to the postoperative pictures on our website under the “Resources” tab to see examples of how the bandages and gauze normally appear. You can call our office for the password to these photos, or email us at firstname.lastname@example.org.
The outer gauze and plastic bandage will fall off by themselves. This can even happen the same day as the operation, but we do not replace the bandages, and you do not have to replace any bandages or apply ointments when it comes off.
Sometimes, part or all of the bandage hangs from the penis before it completely falls off. This does not require any treatment by you, but you can gently remove the last attachments if you wish.
Infants may poop onto the bandage, with stool sometimes getting under part of the bandage or on the catheter. Please simply wipe it off gently and do not be concerned if you cannot remove it all — infections after surgery are rare, even when there is soilage.
Outer bandages tend to fall off later in older boys and adults. If they have not come off within about a week after surgery, please have the patient soak in a tub of warm water, which will begin to loosen them so that they will fall off or can be gently removed without hurting. It is very common for the bandages to have an odor after a few days, which will improve once they are removed.
The inner bandage with the rolled Vaseline gauze and the stitches may also fall off at home in active infants and young boys. They generally remain in place in older boys, teenagers, and adults. We recommend this inner bandage be removed 6-7 days after surgery. Our nurse can do this in the office, or a nurse or physician can remove for those living outside North Texas. We recommend soaking in a bathtub prior to your appointment for the bandage to be removed. It is fine for the catheter to go in the bathtub as well. You can visit our YouTube channel (Hypospadias Specialty Center) to watch the video for bandage removal at https://youtu.be/4wzA4X6KALg
Studies indicate hypospadias wounds heal the same whether they are covered with bandages or not, so we encourage you not to be concerned about the bandages, how they look, or when they fall off.
Early Appearance of the Graft
When the bandages all come off and the graft can be seen for the first time, many caregivers are concerned about the appearance of the penis and graft. This is especially true when grafts are taken from inside the lip, as they appear very red. This is normal. During healing - before the 2nd operation - the penis will gradually begin to look quite normal when viewed from the top.
Once the inner vaseline gauze bandages and catheter are removed 1 week after surgery, we recommend using Aquaphor or vaseline several times a day for the next 3 weeks. Starting in 4 weeks (1 month after surgery), please apply betamethasone ointment twice per day for 3 months. A prescription will be provided for this ointment. Once you have completed the 3 month course of betamethasone, no additional care is needed for the graft.
Patients will have a catheter for 6-7 days. We recommend infants and young boys simply have the catheter drain into their diaper or pull-up, which you will change as usual when it is wet or soiled. We do not use double diapers.
Catheters after graft repairs are held in place with water in a small balloon within the bladder. Sometimes the catheter falls out early, in which case we do not replace them if the patient urinates without a problem.
Our nurse can remove the catheter in the office, or you can remove it at home. Use an empty medicine syringe (10 mL) to remove water from the balloon port (the one with the hard plastic cap on it, not from where the urine drains). Place the syringe into the port and pull back to remove all the fluid, usually 2-3 mL for prepubertal boys and 10 mL for older boys, teens, and adults. Once all the water is removed, gently pull the catheter out. This is not painful, just a little uncomfortable for some older boys/men, but be aware that the catheter may be longer than you imagine!
Bathing and Activity
For babies, we recommend sponge baths until the day the inner bandage is going to be removed. Soaking in a bathtub prior to bandage removal can help soften it and make it easier to remove. Older boys, teens, and adults can shower and allow the water to run over the bandages starting 4 days after surgery. Once the inner Vaseline bandage and catheter are removed, we recommend soaking in a warm bath several times a day for the first few days.
Babies are hard to keep still and we don’t expect you to! There are no special activity restrictions in infants. For toddlers and older children, we recommend no straddle toys (such as jumpers, tricycles, bicycles) for 2 weeks, and no coach-directed sports for 2 weeks. Teens and adults should rest in bed for the first 48 hours after surgery, minimizing activity. After that, walking and moving about are ok, but no heavy lifting or sports for 2 weeks.
Infants need only ibuprofen (Motrin or Advil) and Tylenol to control pain after surgery. We recommend you give these on an alternating schedule without waiting to see if they will have pain during the first 48 hours after surgery. You can alternate them, giving first the Tylenol, then 3 hours later the ibuprofen, then 3 hours later another dose of Tylenol, etc.
Older boys, teens, and adults should also take ibuprofen on a regular schedule for the first 48 hours, alternating with either Hycet or Norco (a narcotic that also contains Tylenol) or plain Tylenol.
Older boys, teens, and adults may also experience bladder spasms, which may cause them to feel the need to urinate from the catheter or cause pain around the bladder and penis, like a muscle cramp. To help with this, you should give ibuprofen and a bladder muscle relaxant named oxybutynin (also called Ditropan). Please give oxybutynin on a regular basis, following the instructions on the bottle, whenever your child is experiencing bladder spasms. Teens and adults will be given a relaxant medicine to take at night to help with catheter discomfort.
Narcotics and oxybutynin both may cause constipation, so you may wish to increase fruits and vegetables during recovery. If the patient develops constipation, which can make bladder spasms worse, any over-the-counter laxative (such as Miralax) can be used for relief.
Patients who have a catheter will also be given a prescription for an antibiotic to reduce the risk for urinary infection developing. Sometimes this antibiotic will cause diarrhea. Eating yogurt or giving an over-the-counter probiotic (such as Culturelle) may help with this.
When an oral graft was needed, older boys, teens, and adults are given a prescription to gargle with “Magic Mouthwash” several times a day to help with mouth discomfort.
Except for the stitches holding the Vaseline gauze in place over the graft, there are no stitches that need to be removed. Don’t worry if you see some stitches on our around the graft. These are normal and will dissolve on their own with time.
Temperatures even as high as over 101ºF can be normal the first night after surgery. Fevers and irritability the first few days after surgery may indicate a virus or ear, throat, or lung infection. You should call your primary care physician if this occurs. Wound infections with fever are very unusual after hypospadias repair, and do not occur until about a week after surgery.
It is rare to have an emergency after hypospadias surgery. Most concerns are not urgent and you can email us at email@example.com during normal business hours to ask your question. If you believe there is an urgent issue, you can call us any time at 214-618-4405. We encourage you to first review postoperative photographs on our website before calling if you are worried about how the bandages or wounds look.
Please do not go to the emergency room for problems without first contacting us! Doctors in the emergency room are not surgeons and may not know what the wounds should look like after hypospadias repair. We especially do not want non-specialists to try to replace a catheter or remove the bandages after hypospadias repair before consulting with us. Many times an emailed picture of the area you are concerned about will help us to decide if urgent medical attention is needed.