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Hypospadias Repair

Last updated April 7, 2019

Approved by: Maulik P. Purohit MD MPH

Sadasiv Swain

Hypospadias Repair is a surgical procedure that involves repairing a congenital defect in which the urethra is abnormally positioned.


Background Information:

What are the other Names for the Procedure?

  • Glanuloplasty
  • Meatoplasty
  • Urethroplasty

What is Hypospadias Repair & Urethroplasty surgical procedure?

  • Hypospadias Repair & Urethroplasty is a surgical procedure that involves repairing a congenital defect in which the urethra is abnormally positioned
  • The urethra is a tube that carries urine from the urinary bladder to the outside (for disposal)
  • Hypospadias is a condition, where the urethra does not end at the tip, but on the underside/middle/bottom of the penis, or behind the scrotum
  • A Hypospadias Repair procedure is predominantly performed on male infants and children. But sometimes, it is also performed in adolescents or adults

What part of the Body does the Procedure involve?

A Hypospadias Repair & Urethroplasty procedure involves the urethra.

Why is the Hypospadias Repair & Urethroplasty surgical procedure Performed?

A Hypospadias Repair & Urethroplasty procedure is performed for the following reasons:

  • Prevent development of urinary-tract infections
  • If there are problems with the flow of urine, or the flow of semen affecting fertility
  • If there are problems with erection

What are some Alternative Choices for the Procedure?

A Hypospadias Repair & Urethroplasty procedure remains the gold standard approach for this condition.

What are the Recent Advances in the Procedure?

Use of different types of tissue to rebuild the urethra, has been some of the advances in the procedure.

What is the Cost of performing the Hypospadias Repair & Urethroplasty surgical procedure?

The cost of Hypospadias Repair & Urethroplasty procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Hypospadias Repair & Urethroplasty procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/003000.htm

http://www.chp.edu/CHP/Hypospadias+Repair

Prior to Hypospadias Repair & Urethroplasty surgical procedure:

How is the Hypospadias Repair & Urethroplasty surgical procedure Performed?

  • A Hypospadias Repair & Urethroplasty surgical procedure is performed under general anesthesia
  • It can be done as a one stage procedure, or sometimes, it may require more than one procedure, depending on the severity of the deformity
  • If there is no associated deformity, the urethra is reconstructed using a piece of foreskin from the penis, or tissue obtained from another site (skin from inner arm or buccal mucosa, which is the lining of the mouth)
  • The extra-tissue is used to create a tube that extends the length of the urethra
  • If there is an associated deformity like chordee (increased curvature of the penis), straightening of the penis is performed first, prior to correcting the hypospadias
  • A catheter is placed in the urethra to drain the urine and it is removed 1-2 weeks after the surgery

Where is the Procedure Performed?

A Hypospadias Repair & Urethroplasty procedure is performed in a hospital.

Who Performs the Procedure?

An urologist performs the Hypospadias Repair & Urethroplasty procedure.

How long will the Procedure take?

It may take anywhere between 1-3 hours to perform the procedure.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Hypospadias Repair & Urethroplasty procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Hypospadias Repair & Urethroplasty surgical procedure?

Before a Hypospadias Repair procedure, the patient may need to undergo a routine blood and urine analysis. The physician may suggest further tests depending on the health of the individual and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Hypospadias Repair & Urethroplasty procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place, during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Hypospadias Repair & Urethroplasty surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered, prior to the procedure.

How much Blood will you lose, during the Procedure?

The procedure is less invasive; hence, the amount of blood loss is generally minimal.

What are the possible Risks and Complications during the Hypospadias Repair & Urethroplasty surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Longstanding illness, such as autoimmune disorders, chronic infections
  • Poor immune system due to a variety of causes

The possible risks or complications that may arise during the surgery are:

  • Excessive bleeding
  • Infection surrounding the surgical wound
  • Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Hypospadias Repair & Urethroplasty surgical procedure?

  • After the surgical procedure, the patient shall be sent to an area of the hospital, called postoperative recovery area (PACU)
  • The patient’s blood pressure, heart rate, and respiration cycle, will be closely monitored
  • Any additional pain associated with the procedure, will also be treated
  • Patients are usually discharged from the hospital, the same day the surgery is performed

After the Hypospadias Repair & Urethroplasty surgical procedure:

What are the possible Risks and Complications after the Hypospadias Repair & Urethroplasty surgical procedure?

Post Hypospadias Repair & Urethroplasty procedure, the following complications may arise:

  • Excessive bleeding
  • Infection in the surgical wound
  • Abnormal scarring of the urethra
  • Narrowing of the urethra
  • Urine leak due to improper healing (fistula)

What is the Prognosis after the Surgery?

The prognosis is excellent in most cases and difficulties with erection or orgasms are very rare from Hypospadias Surgery.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the surgical wound
  • Bleeding or fluid drainage from the surgical wound
  • The occurrence of any symptom that causes uneasiness in a child, such as nausea and vomiting
  • The child has developed any signs of an infection
  • Fever
  • Dizziness
  • Feeling sick
  • Muscle aches
  • Headaches
  • Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Hypospadias Repair & Urethroplasty surgical procedure?

At home, the following post-operative care is recommended, after a Hypospadias Repair & Urethroplasty procedure:

  • Complete the course of prescribed medication, as advised by your physician
  • Take antibiotic medication to help combat or prevent infection, as directed by your physician
  • Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain, as necessary
  • Avoid all activities that are physically strenuous for about 6 weeks after surgery

How long does it normally take to fully recover, from the Procedure?

A Hypospadias Repair & Urethroplasty procedure is a complex surgery and may be somewhat different in each case. Recovery is largely dependent on the severity of deformity and the type of repair procedure adopted.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, no tissue is removed; but if it is removed, then it is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The tissue removed is processed in the laboratory under a pathologist's supervision.
  • Slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Hypospadias Repair & Urethroplasty surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • A hospital
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist (if the tissue was sent for analysis)
  • Urologist

The patient is advised to inquire and confirm the type of billing, before the Hypospadias Repair & Urethroplasty procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 6, 2014
Last updated: April 7, 2019