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Postoperative Instructions

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POST-OP SURGERY INSTRUCTIONS

General Instructions for all Surgical Repairs

Wounds:
You should expect plenty of swelling, bruising, and bleeding after surgery. This is normal, and will lessen each day as healing continues. Penis skin is thin and sensitive, so wounds often look more severe than they feel.

Bandages:
Coming out of surgery, you will see a pad of gauze covered in tegaderm, which is a clear sheet of adhesive. There is no rule about how long bandages must remain on. Sometimes they will fall off on their own on day 2, and sometimes they won't start coming off until you can bathe on day 5.

Stitches:
Patients may have stitches beneath the skin, these are dissolvable and will go away on their own. Any stitches that need to be removed will be blue and easy to see, and will be there to hold a catheter or pressure bandage on.

Bathing:
Patients can bathe on the 5th day after surgery. Surgery day is day 1. On day five, he can bathe in warm, soapy water. Soaking will feel good and help with the healing process. Before then, use wipes or sponge bathing to stay clean and comfortable. If the patient has a catheter, it is okay to be submerged in the bath.

Physical Activity:
For the first 2 weeks after surgery, avoid sports, swimming, straddle toys, bicycles, and anything that puts the weight bearing on the surgical site.

Adult patients will ideally be on bed rest for 72 hours, but 48 hours is okay. Adults should avoid any strenuous activity including exercise, lifting, or walking more than necessary for two weeks. No sexual activity for 6 weeks. 

While we specialize in hypospadias, everyone is different, and there are many different repairs our patients could receive, depending on a multitude of contributing factors. Some main categories include a phalloplasty, a distal repair, a straightening repair, a grafting repair, and a tubularizing repair. 

 

For repair-specific post-op instructions, please reference the surgical breakdowns below!

Phalloplasty (1 stage)

Phalloplasty can be used to describe a number of various maneuvers and surgical tactics to get the penis to an anatomical and functional normal. A phalloplasty might involve skin rearrangement, relieving tightness, or resolving a slight bend or twist. No catheter is placed during this repair. Please view the attachments for detailed information and instruction on this repair's bandage care, medications, catheter care, bathing, physical activity, and concerns. 

Distal TIP Repair (1 stage)

The distal TIP, or "Snodgrass Repair" is used to correct a more common but less severe form of hypospadias. Patients receiving this repair have the diagnosis of distal hypospadias. In this scenario, the urinary opening is on or near the head of the penis. Most patients have only partial foreskin development, but occasionally there is a normal foreskin. The penis may appear to be bent downwards or twisted to the side. Surgery is recommended for many of these patients. A distal TIP repair will involve straightening the penis, moving the urine opening to the tip of the penis, and, depending on the desire of the patient or patient's parent, performing circumcision or reconstructing the foreskin to look normal, all accomplished in one surgery. Following this repair, the patient will have a catheter for 6-7 days. Please view the attachments for detailed information and instruction on this repair's bandage care, medications, catheter care, bathing, physical activity, and concerns. 

MULTI-STAGE REPAIRS

Patients that undergo a staged surgical approach will have some variation of the following. The straightening, grafting, and tubularizing repairs are parts of a "staged repair", because they are three different stages of one overall repair. Depending on many factors such as degree of curvature, surgical history, and patient specific needs, a patient requiring a staged repair may not need all of the stages broken apart/individualized. Regardless of how many surgeries are needed, a healing period of at least 6 months is required between each repair. Please view the attachments for detailed information and instruction on this repair's bandage care, medications, catheter care, bathing, physical activity, and concerns. 
If surgery is split into 3 different surgeries: 
Some hypospadias repair are more severe with severe bending, scar tissue, and/or very deficient skin n which surgery need to be broken into three separate surgeries. The first would still be straightening his penis because that is the first concern always in repairing hypospadias. In this case we do not want to cause too much trauma to the surgery site so we sew his penis up completely and let that heal for 6 months. Most parents are surprised because his penis will look completely normal but he will be urinating from an opening lower than normal.
The next surgery would then be placing a graft because his urine channel is still short and if any of it was unhealthy, had to be removed to make sure things would heal properly. The graft would be placed and in 6 months would be completely healed. The last surgery would involve taking both ends of the graft and sewing them together so that he urines from the tip of his penis.

 

Quick Recap: 
Just a quick recap if surgery is in 3 parts:
- Surgery 1: will be straightening the penis
- Surgery 2: will be placing a skin graft from the tip of the penis to the urinary opening

- Surgery 3: will be tubularizing the skin graft (not the penis!) so that the opening is at the tip.

Just a quick recap if surgery is in 2 parts:
- Surgery 1: will be straightening and lengthening the penis
- Surgery 2: will be tubularizing the penis so that the opening is at the tip

 

Fistula Repair: 
Fistula repair is a surgical procedure performed to close an opening that is leaking urine below the tip of the penis. This opening, called a fistula, is one of the most common complications after hypospadias repair. The goal of surgery is to restore normal urine function at the tip of the penis.

Straightening repair (1 of 3 surgeries)

The straightening repair exists to straighten the penis. This repair is typically done on patients severe ventral curvature as well as a urine channel that will not sufficiently reach the tip of the penis. This repair will be followed by both a grafting and tubularizing repair. Following this repair, the patient will have a catheter for 6-7 days. Please view the attachments for detailed information and instruction on this repair's bandage care, medications, catheter care, bathing, physical activity, and concerns. 

Skin Grafting (2 of 3 surgeries OR 1 of 2 surgeries)

The grafting repair provides tissue for a new urethra, long enough to reach the tip of the penis. Depending on the patient, this skin may be taken from the foreskin or the mouth. Outside of our practice, you may hear someone call this repair a "1st stage repair." In this case, a grafting repair is enough to both straighten and lengthen the penis, while also providing the foundational tissue for a new urethra that will reach to the tip of the penis. The skin graft is shaped like a rectangle and is placed flat on the penis to develop its new blood supply. The urinary channel remains in its lower position along the shaft of the penis or near the scrotum. Following this repair, the patient will have a catheter for 6-7 days, as well as a bandage that secures the skin graft into place. This inner bandage is secured with several stitches that will be removed at the time of the catheter removal 1 week after surgery.

Tubularizing Repair (3 of 3 surgeries OR 2 of 2 surgeries)

The tubularizing repair is to roll the previously laid graft tissue into the new urethra that reaches the tip of the penis. This repair is done on patients who, 6 or more months prior, had a grafting repair with us. This is the final step of a staged repair. Following this repair, the patient will have a catheter for 14 days. Please view the attachments for detailed information and instruction on this repair's bandage care, medications, catheter care, bathing, physical activity, and concerns. 
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