Hypospadias Specialty Center POSTOPERATIVE INSTRUCTIONS
Hypospadias Repairs — 2nd Stage Repair
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 plastic bandage wrapped around the penis, then a white gauze placed over that covered by a second, larger plastic bandage.
The gauze will turn red from the normal oozing of blood, 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 plastic bandages and the gauze all fall off spontaneously at home. 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. However, it is very common for the bandages to have an odor after they have been in place for a few days.
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.
On some children and most teenagers and adults, a stretchy bandage is wrapped around the penis to help decrease swelling. If this hasn’t come off on its own by 5-7 days postoperatively, soak in a tub and unravel the bandage to remove. Applying vaseline or Aquaphor may help remove it as well.
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.
When the bandages come off, you do not need to apply any ointments to the penis. If the penis is tending to stick to diapers or underwear, some Vaseline or Aquaphor ointment can be applied to the diaper/pull-up where the penis will be in order to prevent sticking.
Patients will have a catheter for 5-14 days, depending on the extent of the hypospadias. 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 are held in place only by the blue stitch at the head of the penis. Sometimes they fall out early, in which case we do not replace them if the patient urinates without a problem or pain. If the catheter is found dangling by the blue stitch, you can cut the stitch to remove it completely. If the stitch is pulling on the head of the penis and appears to be causing pain, you can apply a little Vaseline or Aquaphor ointment and gently adjust so that the stitch is no longer pulling.
Our nurse can remove the catheter in the office, or you can remove it at home. Simply cut one side of the blue stitch, and then gently pull the catheter out. This is not typically painful, but the catheter may be longer than you imagine! You can visit the Hypospadias Specialty Center YouTube channel to watch a video of catheter removal (https://youtu.be/ole5zQZK8xY).
Teens and adults have the catheter held in place with a stitch and usually water in a balloon within the bladder. This water will need to be removed before removing the catheter. 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 about 10 mL. Once all the water is removed gently pull the catheter out.
We recommend you sponge-bathe the patient for 48 hours after surgery. Then he can resume bathing. Older boys, teens, and adults can shower after 48 hours. The bandages can get wet, and water can enter the catheter without concern for infection. Once the catheter comes out, we recommend soaking in a warm bath several times a day to help with discomfort and swelling.
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 ibuprofen, then 3 hours later the Tylenol, then 3 hours later another dose of ibuprofen, 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.
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.
Except for the stitch holding the catheter in place, there are no stitches that need to be removed. You may see some stitch material on the penis or scrotum, and these will dissolve on their own.
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.
Occasionally, the skin edges may separate, especially around the base of the penis or within the scrotum and you may see some blood or yellowish discharge. If the skin is red, warm to touch, and causing increased pain, please call our office. Otherwise, skin separation will usually heal on its own. Soaking in a warm tub several times a day may help, and you can apply Aquaphor ointment or Bacitracin to the area while it is healing.
Babies do not have activity restrictions. Toddlers and older children should not use straddle toys like jumpers or bicycles for 2 weeks after surgery. No coach-directed sports activities or swimming for 2 weeks after surgery, then you can resume like normal. Teens and adults should be on bed rest for the first 48-72 hours after surgery, then no heavy lifting for 2 weeks.
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 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.