Surgery for hypospadias
(child)
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!! What is hypospadias?
Hypospadias is a condition where the opening of
the urethra (tube that carries urine to the penis)
opens on the underside rather than at the tip. 1 in
250 boys has hypospadias and the condition can
run in families.
The foreskin usually looks incomplete or open on
the underside (see figure 1).
Incomplete
foreskin
Opening of the
urethra
Figure 1
Mild hypospadias
In severe cases the opening of the urethra is
further away from the tip and the shaft of the
penis can curve down (see figure 2).
Opening of the
urethra
Figure 2
Proximal hypospadias
The operation is usually planned for when your
child is 6 to 24 months of age. Your surgeon may
recommend waiting until he has been
potty-trained before having the operation. It is
never too late to have the operation.
Your surgeon has recommended an operation
for your child. This document will give you
information about the benefits and risks to help
you to be involved in the decision.
If you have any questions that this document
does not answer, ask your surgeon or the
healthcare team.
What are the benefits of surgery?
When a boy is urinating, it is easier for him to aim
the stream of urine if the opening of the urethra
(meatus) is at the tip of the penis.
If the shaft of your child’s penis is severely
curved, surgery should improve the function of
his penis for sex later in life.
You may prefer the appearance of a penis that is
either circumcised or has a complete foreskin,
and with the urethra opening at the tip.
Are there any alternatives to surgery?
Surgery is the only way to move the opening of
the urethra to the tip of your child’s penis and to
improve the appearance of his penis.
It is best for your child to have the operation when
he is 6 to 24 months of age but surgery can be
performed at any time. If you decide to wait, do
not have him circumcised, as sometimes the skin
of the foreskin is used as part of the operation.
If the shaft of your child’s penis is not too severely
curved, he may not have any problems later in
life.
What will happen if I decide that my child will
not have the operation?
The position of the opening of the urethra will stay
where it is and the shape of your child’s penis will
not change.
Depending on how severe the problem is, he
may get problems urinating and having sex later
in life.
Your child may be self-conscious about the
appearance of his penis following puberty.
What does the operation involve?
The healthcare team will carry out a number of
checks to make sure your child has the operation
he came in for. You can help by confirming to
your surgeon and the healthcare team your
child’s name and the operation he is having.
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The operation is performed under a general
anaesthetic. Your child may also have injections
of local anaesthetic to help with the pain after the
operation.
Your child may be given antibiotics during the
operation to reduce the risk of infection.
Surgery for hypospadias is complex and
depends on where the opening of the urethra
needs to be moved from and how severely
curved the shaft is. The repair may need to be
performed over several operations and each
operation usually takes one to two hours.
If the opening is close to the tip, sometimes just
one operation is enough to widen or change the
shape of the opening (meatoplasty). This can be
combined with a procedure that changes the
appearance of the opening. Your surgeon may
also need to create a small section of tube, using
skin from the head (glans) or shaft of the penis.
Your surgeon will reconstruct the foreskin or
leave the penis looking circumcised.
If the opening is further away from the tip, your
surgeon will first check if the penis needs to be
straightened. This involves an injection to create
an artificial erection to see how curved the penis
is. Mild curvature can be treated by releasing
some of the skin on the underside of the penis.
More severe curvature may need a graft or a
procedure that uses stitches to straighten the
shaft.
Your surgeon will need to create a new section
for the urethra between the opening and the tip of
the penis. This may involve using a skin graft,
usually taken from your child’s foreskin. Your
surgeon will stitch the urethra graft in place
between the opening and the tip of the penis.
To complete the repair, your surgeon will use the
graft to create a tube and will close the head of
the penis around the tube. Your child’s penis will
usually look circumcised after this type of repair.
This stage may need to be completed a number
of months later. Some boys need several
operations and your surgeon will discuss this with
you.
At the end of each operation, your surgeon will
usually place a catheter (tube) into your child’s
bladder to help him pass urine. They will usually
place a dressing on his penis to help protect the
repair.
What can I do to help make my child’s
operation a success?
You can reduce your child's risk of infection in a
surgical wound.
• Your child should be given a bath or shower
either the day before or on the day of the
operation.
• Your child should be kept warm around the
time of the operation. Let the healthcare team
know if your child feels cold.
What complications can happen?
The healthcare team will try to make the
operation as safe as possible but complications
can happen. Some of these can be serious and
can even cause death. You should ask your
doctor if there is anything you do not understand.
Your doctor may be able to tell you what the risk
of a complication for your child is.
1 Complications of anaesthesia
Your anaesthetist will be able to discuss with you
the possible complications of having an
anaesthetic.
2 General complications of any operation
• Pain. Sometimes a short pain called bladder
spasm can happen while the catheter is in place.
The healthcare team will give your child medicine
to control the pain and it is important that they
take it as you are told.
• Bleeding during or after the operation. This
usually stops but your child may need another
operation (risk: less than 1 in 100) and a blood
transfusion. Bleeding is more likely to happen if
your child's blood does not clot properly. It is
important to let your doctor know if your child, or
anyone in his family, has this problem.
• Infection of the surgical site (wound) (risk: 1 in
50). It is usually safe for your child to shower after
the dressing and catheter have been removed
but you should check with the healthcare team.
Let the healthcare team know if your child gets a
high temperature, you notice pus in his wound, or
if the wound becomes red, sore or painful. An
infection usually settles if you keep the area clean
and use anti-bacterial ointment but your child
may also need antibiotics.
• Unsightly scarring of the skin.
3 Specific complications of this operation
• Problems with the catheter. A blocked
catheter can usually be flushed out. If the
catheter falls out, the dressings on the penis may
need to be changed and the catheter may need
to be placed in your child's bladder again.
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• Developing a small hole (fistula) in the
reconstructed urethra or foreskin, causing an
extra stream of urine or drip when your child
urinates.
• Narrowing of the opening of the urethra
(meatal stenosis). This leads to difficulty passing
urine and can also cause the urethra to stretch
(dilate). Your child may need another operation.
• Narrowing of the urethra. This is usually
caused by scarring or by a foreskin condition
called balanitis xerotica obliterans (BXO), where
the skin becomes thickened and white. This is
difficult to treat and your child may need another
operation.
• Skin-graft problems (risk: less than 1 in 10).
The graft can be rejected or shrink. Your child will
need another operation.
• Breakdown of the repair (risk: 1 in 20). The
risk increases the further away the opening was
from the tip of the penis.
• Cosmetic problems. It is difficult to predict
exactly what the penis will look like. Your child
may choose to have a cosmetic procedure later
in life.
How soon will my child recover?
• In hospital
After the operation your child will be transferred to
the recovery area and then to the ward. He
should be able to go home the same day or the
day after. However, your doctor may recommend
that your child stays a little longer. The healthcare
team will advise you on how to keep the dressing
and catheter clean.
If you are worried about anything, in hospital or at
home, contact the healthcare team. They should
be able to reassure you or identify and treat any
complications.
• Returning to normal activities
Keep your child away from other children,
including from nursery or school, while the
catheter and dressing are in place.
Your child can do normal activities but should not
play rough or play sports during this time. Make
sure he does not interfere with the catheter or the
dressing. The healthcare team will show you how
to look after the catheter and the dressing.
When the dressing is removed, your child’s penis
may look sore, swollen and bruised. He can
bathe but do not directly wash the penis. Dry the
area gently.
For the first few days give your child simple
painkillers and encourage your child to drink
plenty of fluid to help him pass urine more easily.
Some boys have difficulty passing urine while the
penis is swollen and need another catheter until
the swelling settles.
Your child should not swim until two to three
weeks after the dressing has been removed.
• The future
For most boys, surgery for hypospadias is
successful and they have a penis that looks and
works more normally. However, the surgery is
complex and your child may develop a serious
enough complication to need another operation
(risk: less than 1 in 5).
Summary
Hypospadias is a condition where the opening of
the urethra opens on the underside of the penis.
Sometimes the shaft of the penis can curve
down. Surgery aims to move the opening of the
urethra to near the tip of the penis and to improve
the shape of the penis.
Surgery is usually safe and effective but
complications can happen. You need to know
about them to help you to make an informed
decision about surgery for your child. Knowing
about them will also help you to help the
healthcare team to detect and treat any problems
early.
Keep this information leaflet. Use it to help
you if you need to talk to the healthcare team.
Acknowledgements
Author: Mr Alun Williams FRCS (Paed. Surg.)
Illustrations: Medical Illustration Copyright © Nucleus
Medical Art. All rights reserved. www.nucleusinc.com
This document is intended for information
purposes only and should not replace advice
that your relevant healthcare professional would
give you.
You can access references online at
www.aboutmyhealth.org. Use reference PS19.
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