Distal Hypospadias Repair – Infants and Younger Boys

Most patients recover from Hypospadias Surgery without significant problems or complications. However, when the bandages come off, the penis will show swelling and bruising sometimes extending down and around the testicles which is normal. This swelling and bruising will gradually improve over the first 6 weeks. It may take a few months before the skin appears and feels completely normal. 

 

BANDAGE CARE AND BLEEDING: 

There is a plastic bandage wrapped around the penis, then a white gauze placed over the penis covered by a second, larger plastic bandage. The penis will be taped upwards toward the belly. The outer gauze may turn from the normal oozing of blood after the operation, which can occasionally leak through the bandages and onto clothes. 

If bleeding occurs, please apply pressure to the surgical site for 15 minutes, and the bleeding typically will stop. If bleeding continues, attempt the maneuver once more but apply pressure for 20 minutes. If bleeding persists, call the office at 214-618-4405 ext. 2 

If you are concerned about bleeding, you may send a picture to care@hypospadias.com for further assessment. 

The outer gauze bandages will fall off by themselves after a few days or when showering. Sometimes, part or all the bandage may hang from the penis before it completely falls off. This does not require any treatment by you. 

Please refer to the post-operative pictures on our website located under "Resources" tab to see examples of the normal appearance of the bandages and gauze. 

The password to these photos is "PARC" (all caps). 

***Remember, bruising, bleeding, and swelling of the penis after surgery is very normal for a few weeks 

Showering/bathing is allowed on day 5 after surgery. Soaking in water can help loosen the bandages prior to the catheter removal, if the bandages have not already fallen off. It is very common for the bandages to have an odor after a few days. The odor will improve once the bandages fall off or are removed. 

***Please soak in a tub prior to your catheter removal appointment to ensure ALL outer bandages and tapes are removed. The catheter can be submerged into the bath tub. 

 

WOUNDS: 

Occasionally, the skin edges may separate, especially around the base of the penis or within the scrotum and you may see blood or yellow colored discharge. 

If the skin is red, warm to the touch, and causing increased pain, please call the office. Otherwise, skin separation will usually heal on its own. 

 

OVER THE COUNTER AND PRESCRIPTION CREAM/OINTMENT: 

Aquaphor Application: Once the bandages fall off or are removed, you will begin to apply Aquaphor all over the underside of the penis as well as any incision lines around the head of the penis. 

Aquaphor is applied several times per day for 6 weeks to keep the incision adequately moisturized unless otherwise instructed. 

Steroid cream Application: In addition to Aquaphor, sometimes a steroid cream will be prescribed and you will be told a specific date on when to begin the steroid cream (1 month after surgery). 

The steroid cream is applied twice per day for 3 months. 

Please be sure to massage the steroid into the penis as it increases the elasticity of the skin which is beneficial for proper healing. 

Once you have completed the 3 month course of the steroid, no additional care is needed but you may continue moisturizing with Aquaphor as desired. 

TIP: It may be useful to wear a Maxi-pad or Jock Strap to prevent Aquaphor or Steroid Cream/Ointment from transferring to your underwear or clothes. It is best to apply both Aquaphor and Steroid generously to keep the penis well moisturized until fully healed. 

 

CATHETER CARE AND REMOVAL: 

Catheter will be in place by a stitch at the head of the penis for 7 days. There is no balloon in this catheter. Infants and boys under the age of 7 will have the catheter drain into a diaper or pull up, while older boys will have urine draining to a leg bag. 

Leg bags are to be emptied at the times you would normally go to the bathroom or when the bag is full of urine. 

Catheter removal: Clip the large stitch at the tip of the penis, pull out the stitch, then gently pull the catheter out as slowly or quickly as you feel comfortable. Catheter removal should not be painful but may be uncomfortable. Be aware the catheter may be longer than you expect. 

 

BATHING AND SHOWERING: 

Showering/bathing: may begin on the 5th day after surgery. Allow the water to run across the bandages if they are still intact. After showering, be sure to dry the bandages fully. 

***A swim diaper is recommended during bath time if your son is interested in the catheter. This will keep him from pulling it out accidentally. 

Soaking prior to catheter removal: It is necessary to soak in a bathtub prior to the catheter removal so that ALL bandages and tapes have be removed. Once the catheter is removed, it is recommended to soak in a warm bath several times a day as needed to help with swelling, bruising, and bleeding. 

 

PHYSICAL ACTIVITY: 

***Be very careful with diaper changes while the catheter is in place. 

Babies: No use of straddle toys such as jumpers or any baby wearing for 2 weeks. 

Toddlers and older children: 

о No use of straddle toys such as jumpers or bicycles, or any swimming for 2 weeks. 

No coach directed sports/activities for 6 weeks following surgery for older boys. 

 

PRESCRIPTION MEDICATIONS FOR POST-OPERATIVE RECOVERY: 

Infants (Patients under 1 year of age): 

• Ibuprofen (Motrin/ Advil) and Acetaminophen (Tylenol) are the only medications needed to control pain after surgery. 
• Motrin and Tylenol are given on an alternating schedule every 3 hours, this schedule is recommended for the first 48 hours after surgery and can be continued as needed for discomfort. 

Toddlers/Older Boys (over 1 year of age): 

• Ibuprofen (Motrin/ Advil) and Hycet (liquid narcotic also containing Tylenol), or Norco (oral narcotic also containing Tylenol), or plain Tylenol (acetaminophen). 
• Hycet or Norco and Motrin are given on an alternating schedule every 3 hours, which will be provided to you separately after surgery. This schedule is recommended for the first 48 hours after surgery. After that, you can switch to alternating ibuprofen and Tylenol as needed for discomfort. 
• Oxybutynin- helps with bladder spasms. Bladder Spasms are similar to a muscle cramp, and common to experience but may cause a sensation to urinate from the catheter or pain. To help with this, ibuprofen can be taken or oxybutynin, which is a prescription muscle relaxant. 

Take as directed on the bottle and on a regular basis as prescribed until catheter is removed. 

• Norco, Hycet and oxybutynin may cause constipation which can make bladder spasms worse, therefore it is recommended to increase intake of foods with fiber such as fruits and vegetables during recovery. 
• If constipation occurs, any over the counter stool softener such as Colace or a gentle laxative such as Miralax can be taken for relief. 

 

REMOVABLE/DISSOLVABLE STITCHES: 

Except for the stitch holding the catheter in place, there are no stitches that require removal. You may see some visible stitch material on the penis or scrotum which will dissolve on their own. 

The stitches can cause small pimple-like bumps on the penis and scrotum which will resolve over time. 

 

FEVER AFTER SURGERY: 

Temperature as high as 101°F can be normal the first night after surgery. 

Fevers and irritability for the first few days after surgery may indicate a virus or ear, throat, or lung infection especially if you traveled for surgery and were exposed to illness. Contact your primary care physician if this occurs. 

Wound infections with fever are very rare after Hypospadias Repair and do not occur until about 1 week after surgery. 

 

CONCERNS: 

Emergencies are rare after Hypospadias Surgery. Most concerns are not urgent and during normal business hours you may direct any questions or concerns to care@hypospadias.com 

We encourage you to first review post-operative pictures on our website before calling if you are worried about the appearance of the wound or bandages. 

Please call 214-618-4405 at any time for emergent/urgent questions or concerns to speak with a clinical staff. If it is after hours, you will be directed to follow the prompts to connect with one of our doctors. 

***Please DO NOT go to the emergency room for problems without first contacting our office! 

Doctors in the emergency room are not surgeons and may not know what the wounds should look like after Hypospadias Repair Surgery. 

We do not want non-specialists to attempt replacing a catheter after Hypospadias Repair before consulting with our doctors prior. 

Many times, an emailed picture of the area of concern is all we need to help answer your questions. 

There are RARELY urgent issues that need immediate attention in an emergency room. Be sure to call our office to discuss first.