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Pediatric Urology

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Pediatric Urology


Hypospadias Repair

Hypospadias repair is surgery to correct a birth defect in boys in which the urethra (the tube that carries urine from the bladder to outside the body) does not end at the tip of the penis. Instead, it ends on the underside. In more severe cases, the urethra opens at the middle or bottom of the penis, or in or behind the scrotum.

Description

Hypospadias repair is usually done when boys are between 6 months and 2 years old. It is done on an outpatient basis. It rarely requires an overnight stay in the hospital.

Boys who are born with hypospadias are not circumcised at birth, so their foreskin can be used for the repair during surgery.

Before surgery, your child will receive general anesthesia. This will make him sleep and unable to feel pain during surgery. Mild defects may be repaired in one procedure. Severe defects may need two or more procedures.

The surgeon will use a small piece of foreskin or tissue from another site to create a tube that increases the length of your son's urethra. Extending the length of the urethra will allow it to open at the tip of the penis.

During surgery, the surgeon may place a catheter (tube) in the urethra to make it hold its new shape. The catheter may be sewn or fastened to the head of penis to keep it in place. It will be removed 1 - 2 weeks after surgery.

Most of the stitches (sutures) used during surgery will dissolve on their own and will not have to be removed later.

Why The Procedure Is Performed

Hypospadias is one of the most common birth defects in boys. This surgery is performed on most boys who are born with hypospadias. 
If repair is not done, your son may have:

  • Problems controlling and directing his urine stream
  • A curve in the penis during erection
  • Problems with fertility

Surgery is NOT needed if the condition does not affect normal urination while standing, sexual function, or the deposit of semen.

Risks

Risks for any anesthesia are:

  • Allergic reactions to medicines
  • Breathing problems

Risks for any surgery are:

  • Bleeding
  • Blood clot
  • Infection
Other Risks For Hypospadias:
  • A hole that leaks urine (fistula)
  • Large blood clot (hematoma)
  • Scarring or narrowing of the repaired urethra
Before The Procedure

Your child's surgeon may ask for a complete medical history and physical exam of your child before the procedure.

Always tell your child's doctor or nurse:

  • What drugs your child is taking
  • Include drugs, herbs, and vitamins you bought without a prescription.
  • Tell them about any allergies your child has to medicine, latex, tape, or skin cleaner.

Ask your child's doctor which drugs your child should still take on the day of surgery.

On The Day Of The Surgery:
  • Your child will usually be asked not to drink or eat anything after midnight the night before surgery.
  • Give your child any drugs your doctor told you to give your child with a small sip of water.
  • Your child's doctor or nurse will tell you when to arrive for the surgery.
  • The doctor will make sure your child is healthy enough for surgery. This means your son should not have any signs of illness. If your son is ill, the surgery may be delayed.
After The Procedure

Right after surgery, your son's penis will be taped securely to his belly so that it does not move.

Often, a bulky dressing or plastic cup is placed over the penis to protect the surgical area. A urinary catheter (a tube used to drain urine from the bladder) will exit the dressing to allow urine to flow freely into the diaper.

Your child will be encouraged to drink fluids so that he will urinate. Urinating will keep pressure from building up in the urethra.

Your son may be given medicine to relieve pain.

You will probably be able to take your child home the same day as the surgery. If you live a long way from the hospital, you might want to stay in a hotel near the hospital the first night.

Your healthcare provider will explain how to take care of your son at home after leaving the hospital.

Prognosis

This surgery lasts a lifetime. Most children do well after this surgery. Your son's penis will look almost or completely normal. It will also work almost or completely normally.

If your child has a complicated hypospadias, he may need more operations to improve the penis' appearance or to repair a hole or narrowing in the urethra.

Follow-up visits with a urologist (a doctor who specializes in the treatment and surgery of the urinary system) may be needed once your son has healed from surgery. Sometimes a visit is needed when boys reach puberty.

Pyeloplasty:

A pyeloplasty is an operation to remove a blockage in one of the ureters. The blockage in one of the ureters is stopping urine flowing easily from the kidney into the bladder. The blockage is usually present from birth, but occasionally may appear later. If the ureter remains blocked, the kidney could become swollen and damaged. Sometimes, the blockage is caused by blood vessels getting in the way of the ureter. In this case, they will be moved and secured away from the ureter during the operation, but not removed.

What Happens Before The Pyeloplasty?

You will receive information about how to prepare your child for the operation in your admission letter. We will also invite you to come to a pre-admission clinic. This is an outpatient appointment where you will be able to discuss the operation with the team before coming in to hospital. Your child will also have various tests and investigations during this appointment. This avoids any delays on the day of the operation. On the day of the operation, your child should not have anything to eat or drink before the operation, for the amount of time specified in the letter. It is important to follow these instructions; otherwise your child's operation may be delayed or even cancelled. Your child's surgeon will visit you to explain about the operation in more detail, discuss any worries you might have and ask you to give your permission for the operation, by signing a consent form. An anaesthetist will also visit you to explain about the anaesthetic and pain relief after the operation. If your child has any medical problems, such as allergies, please tell the doctors. Please also bring in any medicines your child is currently taking.

What Does The Operation Involve?

The operation is carried out under general anaesthetic and lasts for between 1½ and 2½ hours. The blockage can either be removed using keyhole surgery (laparoscopy) or traditional open surgery. Your surgeon will discuss with you which method is most appropriate for your child. In keyhole surgery, the surgeon uses a telescope, with a miniature video camera mounted on it, inserted through a small incision (cut) to see inside the abdomen. Carbon dioxide gas is used to inflate the abdomen to create space in which the surgeon can operate using specialised instruments that are also passed through other smaller incisions (cuts) in the abdomen. The small incisions are covered with Steristrips. In traditional open surgery, the surgeon will make an incision (cut) in his or her side over the kidneys. The incision will be closed using dissolvable stitches and covered with Steri-strips®. Whichever method is used, the surgeon will locate the blockage in the ureter, remove the affected section and join the cut ends of ureter again. They will insert either a blue stent or a JJ stent into the ureter to keep it stable while it heals. Both types of stent will need to removed some weeks after the operation The blue stent is removed on the ward one week after surgery. The JJ stent is removed in a short procedure under anaesthetic around six weeks after the operation.

Are There Any Risks?

There is a chance that keyhole surgery will not be possible for your child. Sometimes the surgeon will not be able to carry out an operation using the keyhole method for technical reasons, or because of unexpected findings. If this is the case, the surgeon will carry out the operation using a larger incision (cut) instead. All surgery carries a small risk of bleeding during or after the operation. There is a risk that bleeding could occur when the surgeon removes the blocked section of ureter, but usually there is only a small amount of bleeding, which does not cause any problems. There is a risk that urine could leak from the join in the ureter. Placing a tube ('blue stent') in the ureter to drain urine can help prevent this from happening. There is a small chance that the join may narrow so the flow of urine becomes blocked again, which may mean your child would need to have a second operation. There is a risk of infection associated with all types of surgery, but your child will usually continue to take the antibiotics previously prescribed to prevent any infection developing. Every anaesthetic carries a risk of complications, but this is very small. Your child's anaesthetist is an experienced doctor who is trained to prevent and deal with any complications.

What Happens After The Operation?

Your child will recover from the anaesthetic and operation on the ward and will be able to eat and drink soon afterwards, if he or she feels like it. When he or she comes back from the operating theatre, there may be a thin, plastic tube ('blue stent') draining urine from your child's kidney to give the ureter time to heal; this is usually blocked off one or two days after the operation, after which you and your child will be able to go home.

When You Get Home...

It is quite normal for your child to feel uncomfortable for a day or two after the operation. Usually paracetamol will be enough to relieve any pain, if you give it every four to six hours for the next day or so. If your child needs stronger medicine, we will give you some before you go home. If when you get home you feel that your child needs more powerful pain relief medicines, you should call your GP. In the days after the operation, you should encourage your child to drink plenty of fluids to flush out the kidneys. Your child should not have a bath or shower for two days after the operation. After this, it is fine for your child to have a shower, but try to avoid long baths as this may cause the scab to soften and fall off too early. The operation site will be closed with Steri-strips®. The Steri-strips® usually fall off of their own accord, but if they have not fallen off within a week, you can soak them off using a wet flannel.