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 hypospadias without curvature. 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.
Distal Hypospadias Repair
Most patients recover from distal 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 improve over the first 6 weeks, although it may take a few months before the skin appears totally normal.
There is a plastic bandage wrapped around the penis, then a white gauze placed over that covered by a second, larger plastic bandage. The plastic bandages and the gauze all fall off spontaneously at home. 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. 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 surgery are rare, even when there is spoilage. However, it is very common for the bandages to have an odor after they have been in place for a few days. If they have not come off within about a week after surgery, please have the patient 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.
A stretchy bandage is wrapped around the penis to help decrease swelling. If this hasn’t come off on its own by 5-7 days postoperatively, soak in a tub and unravel the bandage to remove. Applying Vaseline or Aquaphor may help remove it as well. Studies indicate distal hypospadias wounds heal the same whether they are covered with bandages or not, so we encourage you not to be concerned about the bandages, how they look, or when they fall off.
When the bandages come off apply Aquaphor to the penis, either directly on his penis (very gently) or on the front of the diaper/pull-up. This will also prevent sticking to the diaper. Please continue this for the first 4-6 weeks of recovery.
Patients will have a catheter for 7 days that will drain into your son’s diaper or pull-up, which you will change as usual when it is wet or soiled. We do not use double diapers, but if you feel more comfortable doing so – that is fine.
Catheters are held in place only by the blue stitch at the head of the penis. Sometimes they fall out early, in which case we do not replace them if the patient urinates without a problem or pain. If the catheter is found dangling by the blue stitch, you can cut the stitch to remove it completely. If the stitch is pulling on the head of the penis and appears to be causing pain, you can apply a little Vaseline or Aquaphor ointment and gently adjust the stitch so that it is no longer pulling.
We recommend you sponge-bathe your child for the first 5 days after surgery, then he can resume bathing. When you bathe your child and the bandages fall off (if they haven’t already) you can submerge him into the water with the catheter and water can enter the catheter without concern for infection. Once the catheter comes out, we recommend soaking in a warm bath several times a day to help with discomfort and swelling.
It is rare to have an emergency after distal 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].