Hypospadias Repair

What is hypospadias repair?

Hypospadias (hi-po-spay-dee-us) repair is a surgical procedure that repairs hypospadias.

Hypospadias is a congenital condition (you're born with it) in which your urethra (the tube where pee and sperm leave your body) doesn’t properly develop in your penis. Another name for the opening of the urethra is the meatus (me-ate-us). The meatus is typically at the end of your penis.

In a baby with hypospadias, their meatus forms in a different location. It may form:

• Near the head of their penis (subcoronal).
• Along their penis shaft (midshaft).
• Where their penis and scrotum meet (penoscrotal). The scrotum is the pouch of skin behind their penis that typically contains their testes.

If your child has hypospadias, they may also have congenital penile curvature (chordee) and penoscrotal transposition (a condition in which their scrotum forms above their penis). Your child’s healthcare provider may need to correct these conditions as well.

Who needs to have hypospadias repair?

If your child has hypospadias, their healthcare provider typically recommends a hypospadias repair between six months to two years after birth. However, as their parent, it’s your decision whether your child will have the repair or not.

Is hypospadias repair necessary?

A hypospadias repair isn’t always necessary. One of the main objectives of hypospadias repair is to make urinating (peeing) and achieving orgasm (ejaculating) easier and more comfortable.

If your child has minor hypospadias, they may not need a hypospadias repair.

Is hypospadias repair a major surgery?

Yes, a hypospadias repair is major surgery. However, some cases of hypospadias are more complicated. Your child may require several more extensive procedures.

How common are hypospadias repairs?

Hypospadias repairs are very common.

Hypospadias is one of the most common congenital conditions in children with penises. Approximately 1 of every 250 to 300 newborn babies has hypospadias.

Milder forms of hypospadias (subcoronal) are more common than severe forms (penoscrotal).

What happens before a hypospadias repair?

Before a hypospadias repair, you’ll meet with your child’s healthcare provider. They’ll evaluate your child’s general health and take vitals (temperature, pulse and blood pressure).

They’ll also perform a physical examination of your child’s penis. They’ll:

• Locate the opening in their penis.
• Ask questions, including how strong their pee flow is, in which direction their pee flows and if there is any spraying or leaking.
• Determine how much curving there is when your child’s penis is erect.
• Perform a cystoscopy or urethrogram, if necessary. A cystoscopy or urethrogram allows your child’s healthcare provider to find any blockages.

Tell your child’s healthcare provider about any prescription or over-the-counter (OTC) medications your child takes, including herbal supplements. Aspirin, anti-inflammatory drugs and certain herbal supplements can increase your child’s risk of bleeding.

Tell your child’s provider about any allergies your child has as well. Include all known allergies, including to medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.

In severe cases, your child’s healthcare provider may recommend giving your child testosterone injections. Testosterone injections help safely increase the length and width of your child’s penis. A larger penis helps improve the odds of a successful surgery.

Your healthcare provider will also give you specific directions on when to give your child food or drinks before the procedure. These directions vary based on your child’s age. It’s important to follow these directions. If your child has fluids or food in their stomach, there’s a chance they could vomit (throw up) while under anesthesia. If they throw up, they may inhale food or fluid into their lungs (pulmonary aspiration). Pulmonary aspiration may cause pneumonia and asphyxiation.

Your child’s healthcare provider will also explain the procedure to you. They may give you tips on keeping calm before the surgery, which helps your child relax. Tips may include paying attention to your body language, facial expressions and tone of voice. Your child may not have the ability or vocabulary to understand what’s happening. Still, they can pick up on your non-verbal cues. The calmer you are, the more relaxed your child will be.

What happens during hypospadias repair?

A special team of healthcare providers specializing in children (pediatrics) will perform a hypospadias repair. The team includes:

• Pediatric urologist.
• Pediatric anesthesiologist.
• Pediatric nurse.

Your child’s pediatric anesthesiologist will sedate your child (put them under) with general anesthesia. They won’t be awake, won’t move and won’t feel any pain during the procedure.

Once your child is asleep, the pediatric urologist uses a sharp, sterile knife (scalpel) to remove a section of your child’s foreskin (a piece of skin that covers the head of their penis). They’ll then use the foreskin to form a tube and attach it to your child’s urethra to make it longer. A longer urethra allows them to move the meatus to the tip of your child’s penis.

Commonly, the pediatric urologist inserts a catheter (stent) into your child’s urethra. A catheter is a soft, hollow tube, usually made out of rubber, silicone or another medical-grade material. A catheter helps your child’s urethra maintain its shape as it heals. It also drains pee. The catheter may remain in place for up to two weeks after the hypospadias repair.

Your child’s pediatric urologist may also make other repairs. Other procedures may include:

• Urethroplasty. A urethroplasty rebuilds the urethra, so pee and semen flow as far forward as possible.
• Meatoplasty (glanuloplasty). During a meatoplasty, a urologist creates a new opening to their urethra and reconstructs the head (glans) of their penis to accommodate the new opening.
• Scrotoplasty. A scrotoplasty repairs the scrotum.

Finally, the pediatric urologist uses dissolvable stitches to close the incisions (cuts). The stitches should dissolve within two weeks.

What are the stages of hypospadias repair?

A hypospadias repair may be a one- or two-stage procedure based on severity.

If your child has mild hypospadias, they usually require only a one-stage hypospadias repair. A one-stage hypospadias repair is only one surgery.

If your child has penoscrotal hypospadias, they require a two-stage hypospadias repair. A two-stage procedure is two surgeries that are usually spaced six months apart. During this procedure, the urologist may use skin from your child’s mouth to help create their new urethra.

How long does a hypospadias repair take?

A hypospadias repair may take up to two to three hours.

What happens after hypospadias repair?

After a hypospadias repair, a healthcare provider covers your child’s stitches with bandages and secure the stent.

The pediatric anesthesiologist stops putting anesthesia into your child’s body to keep them asleep.

Your child moves to a recovery room, where providers wait for them to wake up and monitor their overall health. Most hypospadias repair procedures are outpatient procedures, so your child can go home the same day they have surgery.

Healthcare providers will give you instructions on how to help your child recover, especially for the first week after surgery. They may prescribe your child medication to relieve pain.

Once your child’s healthcare providers determine they’re healthy and no longer require monitoring, they’ll let you take your child home.

How successful is hypospadias surgery in babies?

A hypospadias repair has a high rate of success. Most repairs last a lifetime, and your child’s penis will function normally and healthily.

What are the advantages of hypospadias repair?

The advantages of hypospadias repair include:

• Reconstructing your child's urethra to the tip of their penis to allow for normal peeing and ejaculating.
• Straightening their penis.
• Improved appearance.

What are the risks or complications of hypospadias repair?

All surgical procedures carry some risk. Some risks of hypospadias repair include:

• Anesthesia risks.
• Healing problems.
• Infection.
• Mass of clotted blood (hematoma).
• Swelling.
• Bruising.
• Unfavorable scarring or scarring that causes a change in sensation (feeling).

Risks after hypospadias repair may include:

• Wounds break down. The transplanted skin may not take to the new area.
• Urethrocutaneous fistula. A urethrocutaneous (yer-ree-thro-cue-tay-nee-us) fistula is a hole that forms in the skin of your child's penis and is deep enough to reach their urethra. Pee may leak from a fistula. A fistula may form months or years after a hypospadias repair.
• Urethral stricture. Scarring can narrow their urethra. A narrow urethra can affect how pee flows and create pressure on their kidneys, prostate, bladder and testicles (testes).
• Urethral diverticulum. A bulge in their urethra forms a fluid-filled pouch.
• Shortening of the penis. If you or your child has a hypospadias repair during puberty or post-puberty, their penis may get shorter.
• Recurrent curvature of the penis. Sometimes after a procedure, their penis may return to its previous curved shape.

Other complications after a hypospadias repair may include:

• Weak pee stream or pain when peeing.
• Pain in testicles, sides or lower back.
• Lumps or hard spots on the penis.
• Discomfort during sex.
• Urinary tract infections (UTIs).

What is the recovery time after hypospadias repair?

Most children feel tired after hypospadias repair. They may spend the next several days sleeping more. Sleeping helps them recover faster.

It’s important to remember that your child’s body is unique, so recovery times may vary. In general, swelling and bruising should go away after about two weeks. Many children fully recover after about six weeks.

How do I care for my child after a hypospadias repair?

Keep your child’s penis and other affected areas as clean as possible to prevent infection. Wash your hands with soap and water before handling your child’s bandages. If pee or poop gets on the bandages, gently clean the area with warm, soapy water and pat the area dry. The stent will constantly drain pee, so your child will require more frequent diaper changes as well.

Sponge bathing your child with warm water and soap is OK. Be careful around their affected areas and gently pat the areas dry.

It’s important for your child to take it easy for a few weeks after hypospadias repair to ensure proper healing.

Infants and toddlers should be able to resume many of their activities after two to three weeks. However, they shouldn’t go swimming or play in dirt, sand or mud until fully healed. These activities could lead to an infection.

Older children should avoid playing sports, riding bicycles or other physical play for at least three weeks.

When can my child go back to school or daycare?

You should keep your child home from school or daycare for at least a week or until their provider removes the stent.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider right away if your child experiences any complications or abnormal symptoms after a hypospadias repair. These may include:

• Heavy bleeding in the affected areas.
• A fever of 100 degrees F (38 degrees C) or higher.
• Infection.
• Increased pain.
• Swelling.
• Vomiting three or more times a day.
• Trouble peeing.
• Pee leaking around the catheter.
• The catheter comes out.
• Your child’s diaper is often dry.

Schedule regular follow-up appointments with your child’s healthcare provider. They’ll want to make sure your child’s penis and any other affected areas are healing properly. If your child has severe hypospadias, they may schedule more operations.

Does it hurt to pee after hypospadias surgery?

It may be painful for your child to pee after their healthcare provider removes the catheter. This pain should go away after a few days, but it may take up to two weeks.

A note from Cleveland Clinic

Hypospadias repair is a safe procedure that commonly has good results. A mild hypospadias usually requires one surgery. More severe hypospadias may require more surgeries. If your child needs a hypospadias repair, it’s important for you to advocate for your child and have an open line of communication with their healthcare provider. Be sure to voice what your expectations are for the final results. Your child’s healthcare provider can answer your questions, address your concerns and discuss the realities of what a hypospadias repair can accomplish.