Preoperative instructions for children undergoing hypospadias repair surgery
Hypospadias is often diagnosed at birth or in the first few weeks when a pediatrician does a general examination. It may be a time of great anxiety for the parents when they learn that their child has a urological abnormality which may need surgery.
Parents often wonder about what needs to be done before the hypospadias surgery in terms of preparation. Hence, we have tried to put some of this information in this blog which is more general in nature as the specific information can be only shared by the actual hypospadias expert surgeon managing the child.
Before the surgery, besides the usual tests for fitness to make sure that the blood parameters are fine, we always ask for thorough examination to make sure that the child is not having any other concurrent illness such as respiratory, skin or intestinal infection. If the examination and the tests are normal, then we sit with the family and fix up a date for surgery. If the date is far out, we call for another review 1-2 weeks before hypospadias surgery to ascertain that everything is ready for surgery. Sometimes the parents and families are travelling to Hypospadias Foundation from a long distance away from within India or other countries, then we try to conduct a phone call one week before the hypospadias repair. Some of the key things which you should know before hypospadias repair:
- Empty stomach: The child needs to be empty stomach for atleast 4 hours for breast milk and 6 hours for solid foods/ breads on the day of surgery before surgery. This is a mandatory safety precaution to prevent vomiting during anesthesia. Keeping 6 months or a one-year-old child hungry for 4 hours is not an easy task. Infact some of the parents are more worried about keeping a young child hungry than the actual surgery but this is something which is non-negotiable. Often, we give the child light sedative syrup 1-2 hours before surgery to help the baby sleep. Also, sips of water or apple juice or ORS can be given upto 2 hours before hypospadias surgery.
- Bathing: We ask the parents to give the child a bath on the morning of hypospadias operation as it will be difficult to give a formal head to toe bath for next 7-10 days after surgery. After surgery, we typically instruct the parents to do sponging.
- Potty: Some of the children may be a little constipated, we advise parents to give a glycerine suppository or a laxative the night before so that the child has an empty bowel. Post hypospadias surgery, local pain often leads to temporary constipation. We want the children to have soft stools after surgery.
- Admission to hospital: In a hospital with daycare facility, we admit the child for hypospadias operation at 6:30am -7am. If the parents live farther away from the hospital or the hospital doesn’t have a daycare facility, we like to admit the children the night before surgery. At Hypospadias foundation in Navi Mumbai, India we mostly admit the children in the morning of the surgery itself unless the parents live more than 50km away or do not have a means of traveling early in morning. If the admission is on the same day, then we request the parents to reach hospital at least 1 hour before the scheduled time. Once the room is allotted all the formalities should be fulfilled.
- Carry baby products – wipes, diapers, any special food or milk powder you may be giving and soft toys which soothe them. For bigger children you can carry drawing books or reading books. Carry your basic requirements for one to two days of hospitalization.
- Clothes: Children are changed into hospital clothes appropriate for their age on the morning of surgery. Make sure that the IV canula is inserted after changing clothes.
- Sedation: If the child is irritable while staying hungry, we either advise a pacifier or a light sedative syrup 1-2 hours before the time of anesthesia.
- Induction for anesthesia: Crying child is not a good sight just before hypospadias surgery for the parents or the hypospadias doctor. If the child has an IV line, anesthesia team often administers a small dose of premedication to help sedate the child before shifting to operation theatre.
- Consent for surgery: Before hypospadias surgery is started, family has to fill up an anesthesia and a surgery consent form which is quite detailed in general. Sometimes the parents get alarmed on seeing the long form. But please feel free to ask us about any doubts which you have. We always have the best of intentions and efforts to get your baby back home safely after hypospadias surgery.
All of us must understand that getting the child with hypospadias fully cured is a team effort and it needs devotion and patience from both the family as well as the surgical team. We at Hypospadias Foundation are committed towards making the whole hypospadias treatment experience seamless, less bothersome, more baby friendly and easy for the families. This also translates into better results stemming from deep interest in the wellbeing of babies with hypospadias.
Dr A.K.Singal is a renowned Pediatric urologist in Mumbai, India and also considered the best hypospadias surgeon in India and in the world. He is known for excellent results and devotion to managing children and adults with hypospadias and Disorders of sex development. He along with Dr Ashwitha Shenoy is a senior pediatric urologist working at Hypospadias Foundation. Dr Singal and Shenoy work together running their urology and hypospadias clinics in Navi Mumbai and Mumbai area of western India. Dr Singal is an outspoken advocate of achieving the best results for hypospadias both clinically and psychosocially.