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Hypospadias Surgery - Art and Science


Frequently Asked Questions

Questions regarding Surgery


(for individual questions please send an email)

  1. When should the hypospadias-operation be performed?
  2. Which techniques are preferred for hypospadias-repair?
  3. If the penis is curved, how would it be corrected and is this necessary?
  4. How long does my child have to stay in hospital?
  5. Does my child has to be bed ridden or can he move around after the hypospadias-operation?
  6. How long should the dressing remain on the wound?
  7. How long should the catheter remain in penis?
  8. What is meant by "chordee"?
  9. What is "Nesbit-Procedure" and when should it be performed?
  10. What are the possible complications and how often do they occur?
  11. What happens with the sutures and threads after surgery? Do they need to be removed?
  12. How long does it take for the hypospadias repair to heal and what are the precautions?
  13. When should post operative examinations take place?

12. When should the hypospadias-operation be performed?

Recent studies showed that the ideal time for hypospadias correction is between 3 and 15 months as the penis grows less than 1 cm during the first 3 - 4 years.

 

Fig. 3


13. Which techniques are preferred for hypospadias-repair?

More than three hundred operations have been described for the treatment of hypospadias.

In general the popular techniques for glanular and distal hypospadias include the "Mathieu-" and "Tubularized Incised Plate Technique". For proximal hypospadias popular techniques include "lateral based flap", "onlay, "preputial island flap", "tubularized incised plate technique" and "two-stage-repair".

For glanular hypospadias with mobile meatus, the author prefers to use the "Inverted Y technique". For distal hypospadias, he prefers to use the "Y-V glanuloplasty modified Mathieu" approach. The author has adopted the "lateral-based flap technique"for proximal hypospadias.

 

 

Inverted Y Glanuloplasty

"Inverted Y Glanuloplasty"


Inverted Y Thiersch

"Inverted Tubularised Plate"


Y-V modified Mathieu Technque

"Y-V modified Mathieu Technique"


Lateral Based Flap Technique

"Lateral Based Flap Technique"


14. If the penis is curved, how would it be corrected and is this necessary?

Glanular hypospadias usually has no curvature at all.

80 % of distal hypospadias have no curvature as well. The remaining 20 % have curvature due to shortening of the skin that is usually corrected during the operation of hypospadias.

According to the experience of the author 80 % of the patients with proximal hypospadias have deep curvature that has to be corrected by excision of the fibrous unhealthy tissue that is usually present distal to the urethral opening.15


15. How long does my child have to stay in hospital?

If the patient has glanular or distal hypospadias usually he can go home between 1 - 5 days after the operation depending on the age of the patient, the family circumstances and the degree of swelling after the surgery.

Children with proximal hypospadias need to have a catheter through the abdominal wall into the bladder for about 2 weeks. The child may stay in the hospital up to 2 weeks but may go home earlier if the mother can look after the child and ensure that the catheter does not come out.


16. Does my child has to be bed ridden or can he move around after the hypospadias-operation?

Usually the child is allowed to sit and move around and lead a normal life 24 hours after the operation (however care must be taken to protect the genital area).

However in proximal forms of hypospadias extra care must be taken to avoid slippage of the catheder outside the bladder.


17. How long should the dressing remain on the wound?

In glanular and distal forms the dressing is usually removed within 24 hours after the operation. In proximal the dressing is usually removed after 24 hours after the operation.


18. How long should the catheter remain in penis?

Prof. Hadidi removes the catheter in the penis within the first 2 days because its his believe that the presence of catheter causes irratation and inflammation of the urethra and increases the chances of complications. So in cases of glanular and distal hypospadias the child is allowed to pass urine through the new urethra within 2 days. In cases with proximal hypospadias the author inserts a catheter into the bladder through the abdominal wall and the catheter remains in place for 10 - 14 days.


19. What is meant by "chordee"?

Chordee means downward curvature of the penis. The curvature is usually most obvious during erection, but resistance to straightening is often apparent in the flaccid state as well. Chordee is usually but not always associated with hypospadias.

Essentially, there two main types of chordee associated with hypospadias. Superficial and deep chordee.

The superficial SUPERFICIAL types is usually present in distal hypospadias and in about 20% of proximal hypospadias. It is important to notice that in superficial chordee, the tethering bands and the penile curvarture are present proximal to the hypospadias meatus (Fig). 

Chordee superficial

 

The other common type of chordee is the DEEP  chordee. It is usually present in about 80% of proximal hypospadias and about 10 % of distal hypospadias. It is important to notice that in deep chordee, the hard, rigid tethering bands and the penile curvarture are present distal  to the hypospadias meatus (Fig.)

Chordee deep


20. What is "Nesbit-Procedure" and when should it be performed?

The "Nesbit-Procedure" is a procedure that tries to correct ventral curvature of the penis by shortening the upper surface of the penis. This usually results in further shortening of the penis.

Prof. Hadidi does not recommend this approach for the correction of the penile curvature, as it results in shortening an already short penis.

Nesbit Procedure

 

 


21. What are the possible complications and how often do they occur?

The incidence of complications in glanular and distal hypospadias is less than 5 % if the operation is performed by an experienced surgeon.

The incidence of complications after proximal hypospadias is up to 20 % depending on the experience of the surgeon.

The commonest complication after hypospadias-surgery is fistula, which means that the urine comes from another opening in addition to the meatus. Other complications include infection, disruption of repair, meatal stenosis, loss of the flap, bleeding and disfigurement.

             

 

Fistula

 


22. What happens with the sutures and threads after surgery? Do they need to be removed?

The sutures Prof. Hadidi uses in the hypospadias repair are absorbable (usually within a month). However, some of the threads may take longer than that in some patients. This is normal and should not alarm the parents or the patient. It is important not to try to pull them out, as this may interfere with the healing. Rarely the sutures can leave some tracks in the skin and this is what we call "suture tracks" This does not interfere with the function and usually the appearance of the penis. If it occurs and annoys the patient or the parents they can be excised during the foreskin reconstruction or circumcision.


23. How long does it take for the hypospadias repair to heal and what are the precautions?

The hypospadias repair would heal by about 70 % in one month, for complete healing of the repair this may take up to 6 months (this is one reason why Prof. Hadidi does not recommend any operations during the first 6 months after hypospadias surgery). It would be very important to avoid sport activity which may cause trauma to the penis during the first month of the surgery as well as swimming or bycicle riding.


24. When should post operative examination take place?

The first post-operative examination should take place 3 and the second examination 6 months after the operation. The post operative examinations should be done by the surgeon who performed the surgery.

Lateron an examination every year is recommended.


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