Hi, welcome back to PARC Parent Pointers Video Blog. If you haven’t already go check out my previous videos that discuss frequently asked questions about pre/post hypospadias surgery instructions, FAQ about our practice, and lots more. Today we will be discussing the post-operative care for patients that have distal or proximal hypospadias with a curvature that requires a two-step surgical repair. If you’re not sure what that means please refer back to my previous video on how we determine the number of surgeries your child with a need to fix his hypospadias.
1st stage Hypospadias Repair:
Most patients recover from hypospadias surgery without significant problems or complications. However, the penis usually shows swelling and bruising when the bandages come off, with these sometimes extending down around the testicles. This swelling and bruising gradually improves over the first 6 weeks, although it may take a few months before the skin appears totally normal.
There is a rolled Vaseline gauze lying against the graft and held in place by 3 (sometimes can have up to 5) or so blue stitches tied over the roll. Then there is a regular gauze covering the penis held in place by a plastic bandage. The outer gauze may turn red from normal oozing of blood after the operation, which should not concern you. The outer gauze and plastic bandage will fall off by themselves. This can even happen the same day as the operation, but we do not replace the bandages, and you do not have to replace any bandages when it comes off. Sometimes, part or all of the bandage hangs from the penis before it completely falls off. This does not require any treatment by you, but you can gently remove the last attachments if you wish.
Infants may poop onto the bandage, with stool sometimes getting under part of the bandage or on the catheter. Please simply wipe it off gently and do not be concerned if you cannot remove it all — infections after hypospadias surgery are rare, even when there is soilage.
If the bandages have not come off within 5-6 days after surgery, please have your child soak in a tub of warm water, which will begin to loosen them so that they will fall off or can be gently removed without hurting. It is very common for the bandages to have an odor after a few days, which will improve once they are removed.
The inner bandage with the rolled Vaseline gauze and the stitches may also fall off at home in active infants and young boys. We recommend this inner bandage be removed 6-7 days after surgery. Please soak in a bathtub prior to your catheter removal appointment so that ALL the bandages and tape are removed. It is fine for the catheter to go in the bathtub as well.
Early Appearance of the Graft
When the bandages all come off and the graft can be seen for the first time, many caregivers are concerned about the appearance of the penis and graft. This is especially true when grafts are taken from inside the lip, as they appear very red. This is normal. During healing – before the 2nd operation – the penis will gradually begin to look quite normal when viewed from the top.
Once the inner vaseline gauze bandages and catheter are removed 1 week after hypospadias surgery, we recommend using Aquaphor or vaseline several times a day (anywhere from 4-5 times daily) for the next 3 weeks. Starting in 4 weeks (1 month after surgery), please apply steroid cream twice per day for 3 months – it is fine to use Aquafor as needed during this time. A prescription will be provided after surgery. Once you have completed the 3 month course, no additional care is needed for the graft.
Patients will have a catheter for 6-7 days. We recommend infants and young boys simply have the catheter drain into their diaper or pull-up, which you will change as usual when it is wet or soiled. We do not use double diapers. Catheters after graft repairs are held in place with water in a small balloon within the bladder. Sometimes the catheter falls out early, in which case we do not replace them if the patient urinates without a problem.
How to remove the catheter: Use an empty medicine syringe to remove water from the balloon port (the one with the hard plastic cap on it, not from where the urine drains). Place the syringe into the port and pull back to remove all the fluid, usually 2-3 mL for prepubertal boys and 10 mL for older boys, teens, and adults. Once all the water is removed, gently pull the catheter out. This is not painful, just a little uncomfortable for some older boys/men, but be aware that the catheter may be longer than you imagine!
For babies, we recommend sponge baths for the first 4-5 days, then resume bathing as normal. It is necessary to soak in a bathtub prior to the catheter removal so that ALL the bandages and tape are removed. The day before and the morning of the catheter removal, you should soak in warm water to remove ALL bandages and tape.
Once the inner Vaseline bandage and catheter are removed, we recommend soaking in a warm bath several times a day for the first few days.
It is rare to have an emergency after 1st stage hypospadias surgery. Most concerns are not urgent and you can email us at [email protected] during normal business hours to ask your question. If you believe there is an urgent issue, you can call me any time at 214-618-4405 ext 2. We encourage you to first review postoperative photographs on our website before calling if you are worried about how the bandages or wounds look.
If you have a question or a topic you would like me to discuss in further detail please email me at [email protected]