Hypospadias is a birth defect in males where the urethra, the tube that carries urine from the bladder, does not open at the tip of the penis. Instead, it opens somewhere along the underside of the penis. Surgery is often required to correct hypospadias. After hypospadias surgery, it’s important to follow your doctor’s instructions carefully to ensure proper healing and minimize complications.
Dressing after hypospadias surgery:
As after any surgery, a dressing is required after hypospadias repair as well and the reasons for this are many.
- The dressing helps to prevent infections by creating a physical barrier as well as supports the penis in the healing phase.
- Penis is an organ which tends to swell up after surgery or any trauma and thus a dressing helps to support the organ in the healing phase after hypospadias surgery.
- Besides these two major goals, some surgeons use the dressings to prevent bleeding after surgery but with the refined techniques and more experience, bleeding has become less common issue after hypospadias surgery and we at hypospadias foundation generally use a very loose dressing as prevention of bleeding is generally not the goal for the application of dressing.
Types of dressing done at hypospadias foundation:
- Roll Dressing: This is the most common type of dressing which we use at Hypospadias foundation. At the end of hypospadias surgery, we apply a couple of rolls of thin white gauze (sterile antiseptic dressing along with gauze) just to support the penis. This layer is kept loose and just functions as a soft scaffolding, and we secure it with micropore tape. Also, a transparent cling wrap kind of dressing called – Tegaderm film- is applied around the sterile gauze dressing. This is light in consistency, does not stick to the tissues, is easy to remove and it allows passage of air through it thus aiding in healing. The catheter is secured over the dressing with a micropore, and this step finishes the dressing.
- Sandwich Dressing: In some children, if the dissection has been extensive into the scrotum or the penis length is short, we apply a sandwich type of dressing over the whole area taping the area to lower belly instead of a roll dressing.
- Elastocrepe dressing: Rarely, we apply an elastocrepe dressing to prevent bleeding in the post operative period. Bleeding can occur in children who have received pre surgery hormones to increase the size of the penis and is done after stage 1 repair where extensive dissection for chordee has been done.
We believe a loose dressing after hypospadias surgery allows good blood circulation to operated area after surgery and thus faster healing. Also, we have observed that the pain is much less with this type of dressing. This dressing is also very easy to remove in the outpatient department during follow up.
Double diaper care- At end of dressing, finally the catheter is brought out through a small hole in the inner diaper and left to drain in the outer diaper. Double diapers help in keeping the area snug and dry during the healing process while allowing the children freedom of movement.
Dressing change schedule:
In most of distal hypospadias, we remove the dressing and catheter together on day 7 of surgery. Removing them together avoids one OPD visit for the family.In other type of surgeries, if we decide to keep the catheter for a longer period, we generally change the dressings on day 7-8 and then change them further as needed till catheter is removed.
Technique of dressing removal in the OPD
Dressings are removed in the outpatient unit by the junior doctor or the treating surgeon by gently teasing them out. Sometimes normal saline is used to ease out the dressings by making them wet. We have seen that tegaderm based dressings slip out fairly easily in clinic. The only caution is to make sure that the catheter is not accidentally pulled out while loosening the dressing.
Bleeding after hypospadias Surgery: Minor bleeding after hypospadias surgery is fairly common and happens as penis has very robust blood supply. Generally, this occurs as a small amount of blood spotting or drops of blood at the tip of penis in the first 2-3 days. If the bleeding stops by itself, nothing needs to be done, and this is generally the case. If the bleeding is more in quantity, we ask the parents to visit us, and a tighter dressing may need to be applied.
Soiling, dislodgement & urine leak: Dressings can get dislodged fairly frequently after hypospadias surgery. If this happens then we must redo the dressing.Sometimes the children may have loose motions after hypospadias surgery due to side effects of the antibiotics. These may then leak and stain the dressing. In such a case you should wash away the stools and visit the Hypospadias Foundation/ Mitr Hospital to get the dressing changed. If dressing is left potty stained for long, this may allow the bacteria in potty to cause infection in the freshly operated hypospadias.A small amount of urine leakage by the side of the catheter into the dressing is common. If there is lot of urine leakage by the side of the catheter then this means that the catheter may be blocked. The surgeon can then flush the catheter to relieve the block and the leakage will stop.
Medications after hypospadias surgery:
Medications are required after every surgery to provide comfort to the patient after surgery. Following are the medications which are prescribed after hypospadias surgery.
- Antibiotics: To prevent infection, broad spectrum antibiotics are prescribed after hypospadias surgery. They must be continued till the catheter removal and sometimes for a few days even after the hypospadias catheter is removed. Infection can destroy the entire hypospadias repair hence we need to be vigilant and avoid infection at all costs.
- Pain relievers: After surgery we prescribe pain medications, often starting with acetaminophen(paracetamol) or ibuprofen. The medicines must be given as advised because good pain relief means a comfortable child and in turn leads to good healing after hypospadias repair.
- Bladder antispasmodics: The presence of a urinary tube can cause urinary bladder contractions. The only way to manage this is by prescribing anti spasmodic medicines. Hence after hypospadias surgery till the catheter removal, the child will be on anti-spasmodic medicines.
- Multivitamins and Vitamin C: Vitamins are known to promote healing of tissues. After surgery we prescribe multivitamins and vitamin C which helps in tissue healing at the operated site.
- Pain due to erection: Painful erections after hypospadias surgery occur in every child and are even more prominent in teenagers and adults. This pain can be quite bad due to swelling of penis and the presence of a urinary tube. Hence, we prescribe a stronger painkiller diclofenac in the form of suppository during these episodes of severe pain. This medicine gives good pain relief in times of extreme pain.
At-Home Pain Management Strategies:
- Positioning: Encourage your child to rest comfortably, positioning themselves to minimize tension on the surgical area. This can be lateral or supine position with pillow support.
- Distraction: Engaging your child in their favourite activities or games can help take their mind off any discomfort after hypospadias surgery
- Loose Clothing: Tight clothing can apply pressure on the operated site and cause discomfort to the child. Opt for loose-fitting clothing made from breathable fabrics to avoid irritation.
- Dietary Adjustments: Prefer healthy nutritious food with lot of vegetables, fruits and liquids over processed food. Processed food does not have fibre and cause constipation in a child which in turn can cause bleeding at the operated site during straining. Maintaining hydration is also essential to prevent constipation.
- Hygiene: Maintain proper hygiene around the hypospadias surgical site as instructed by your doctor. Change inner diaper frequently when dirty and be vigilant for soling of dressing. If dressing gets dirty at any point, do visit the hospital and get a hypospadias dressing change.
- Activity Restrictions: Follow the doctor’s recommendations regarding activity levels to promote healing and prevent complications. Any vigorous activities are generally avoided typically for 4-6 weeks after hypospadias surgery. Children can play at home and other board games comfortably.
Remember to consult your hypospadias doctor if the pain seems excessive or worsens, for further evaluation and possible medication adjustments. Healing takes time after a hypospadias surgery. Be patient with your child and offer support throughout the recovery process. Happy children heal faster.
At Hypospadias Foundation India, we have treated thousands of children and adults with hypospadias. Our approach to hypospadias repair includes comprehensive care from preoperative to post operative period. By being prepared, informed, and supportive, you can help your child through this journey and ensure a successful recovery. This approach builds confidence in the parents to manage their child in the post-surgery period.