These instructions are general guidelines and specific changes or instructions for each patient may differ. Please follow instructions given by the child’s surgeon and CHOC Children’s Urology Center staff.
Hypospadias is a condition in which the male urethral opening is not located at the tip of the penis. Chordee is a birth defect frequently associated hypospadias. This information is intended for patients who will be undergoing surgery to correct hypospadias and/or chordee by one of the CHOC Children’s Urology Center specialists at our hospital. The procedure is often considered an “outpatient” surgery in which the child arrives in the morning and leaves the same day. If the child will need to stay in the hospital overnight, the family be made aware of this before the surgery.
Before the Procedure
Please buy over-the-counter antibiotic ointment (i.e. Bacitracin, Neosporin, Polysporin) and ibuprofen, which can be generic or a name brand such as Advil or Motrin. The ibuprofen should be appropriate for your child’s age—infant, child or adult formula.
After surgery, start with clear liquids then progress to a regular diet as tolerated. The anesthesia can cause some stomach discomfort (nausea or vomiting) and a fever 24 to 48 hours after the surgery.
The patient may be given prophylactic antibiotics after the surgery to prevent urinary tract infections. Generally the patient takes the antibiotics for sevent to ten days or until the stent (tube) is removed (if there is a stent present). Please use the antibiotics until the patients is told to stop by our office.
Some children may be sent home with Tylenol #3 to be taken as needed for pain. Most children need it for one to three days. If the doctor prescribed Tylenol #3 (with codeine) tablet or elixir, please try to give it to the patient as little as possible. Codeine causes constipation and can be very painful for the child. Should the child become constipated, we recommend using an over-the-counter stool softener, like Miralax, for relief and to try using ibuprofen instead of the Tylenol #3. Do not take Tylenol #3 and regular Tylenol (also known as acetaminophen in its generic form) at the same time. Taking too much Tylenol (acetaminophen) can cause a harmful overdose. If needed, ibuprofen and ONE Tylenol product can be taken within the same time period.
Also, put crushed ice into a sandwich bag (Ziploc-style bags help prevent leakage) and place this in between the double diapers, or put over underwear to help reduce swelling and pain. Never apply ice directly to the skin.
Patients may be sent home with a stent (small tube) in the urethra, which is held in place with a stitch. It is normal to have a small amount of bleeding and/or clear to yellowish oozing. Sometimes some red/pink colored urine comes out of the stent, and this is normal. The bandage is removed at the child’s first visit after surgery. If the bandage falls off on its own, start applying antibacterial ointment to the surgical site several times per day. If stool gets on the bandage, do your best to clean it off with a baby wipe. If the bandage is covered in stool, please call the on-call doctor and ask if it is alright to remove the bandage early. Call (714) 509-3919 and the answering service will give you directions for the on-call doctor.
The child’s surgeon will provide instructions on when the child may bathe after surgery. At times it is acceptable to bathe with the stent in, and other times it is not. Usually, if the child has a stent in place, we ask the surgical area is not submerged in water and to do sponge baths instead. During the healing process, or about one to two weeks after surgery, bathe three to four times daily in plain water (no soap) for 15 minutes and air dry, once instructed that it is alright to begin bathing. The over the counter antibiotic ointment (not cream) should be applied at each diaper change, or four times each day for one week. If antibiotic ointment is unavailable, Vaseline may also be used.
When the healing skin sticks together, that is called an adhesion. Once the bandage is off, or you are able to see the coronal groove, you can start to help your child avoid creating adhesions. At each diaper change, or four to six times each day, make sure the shaft (body) skin of the penis is not healing to the glans (head) of the penis. Gently pull the shaft skin down towards the body so that you can see the coronal groove go all the way around the penis. The frenulum will be the only area that should attach the glans of the penis to the shaft. Apply antibacterial ointment to the coronal groove to help lubricate the area and prevent “sticking.”
Stent and Dressing Removal
Patients will be given an appointment to return to the office to have the bandage and stent removed. After it is removed, keep bathing him as noted above. You can start tapering the baths down to three per day and then two per day, etc.
For two to three weeks after the surgery the child should avoid trauma to the surgical area—no rough housing, contact sports, bicycle riding or physical education. Younger children should avoid walkers or straddle toys (such as bouncy chairs or rocking horses). At the follow-up appointment (about one week after surgery), our specialists will provide specific information as to when it is safe to return to activities.