When can I have surgery for hypospadias?
Some parents of children with hypospadias are eager to have surgery because it is inconvenient for them to go out with diapers, especially in summer; however, some parents think that they should wait until their children are 4-5 years old and know how to do surgery. The current international age for surgery is 6 months-1 year old, but the penis development of European and American children is generally better than Asian children. During my exchange of techniques for hypospadias in the United States, I saw that the penis diameter of 3-month-old children in the United States had already developed to over 1.5 cm, so they were ready for surgery at 3 months of age.
Since Asian children’s penis development does not agree with Europe and America, we cannot copy the international age of surgery. Most domestic hospitals currently consider the age of surgery to be over 1 year old, but if the penis is well developed, the age of surgery can be brought forward. Parents can measure the maximum diameter of the head of the penis by themselves, and if the maximum transverse diameter (left and right diameter) reaches 1.2-1.3 cm or more, then it is suitable for surgery, otherwise hormone therapy is needed. Surgery too late will affect the child’s mental health.
What should I pay attention to during hospitalization care?
Since a urinary catheter needs to be left in place after surgery, it is a stent for the newly built urethra. Therefore, post-operative care is all about the urinary catheter. The key to postoperative care is to ensure that the urinary catheter is not prematurely dislodged or blocked. The key observation is whether there is a blockage of the urethra: the urethra should not be folded, drink more water so that the exudate can be discharged in a timely manner. A small amount of urine will be discharged from outside the urethral urethra when the child cries or strains to defecate is not a sign of blockage.
If the blockage is confirmed, you need to get a nurse to flush the urinary catheter with salt water. A true blockage is rare, and blockages tend to occur when there is a lot of hematuria and exudate. However, many times it is a false alarm.
How do I observe urination after surgery?
Parents are very nervous on the day of removal and are looking forward to the first urination after surgery. Because the urinary catheter has just been removed, the child may be reluctant to urinate for the first time after surgery because of pain and fear. At this time, parents should encourage their children and turn on the faucet to let them hear the sound of the water flowing.
The first few post-operative urinations are often bifurcated or scattered due to secretions or threads at the urethral opening, which is normal. This is not a case of urinary fistula, and no matter how many bifurcations occur, there is no problem as long as they are discharged from the urethral opening. The best way to observe if there is a urinary fistula is for one person to hold the child and hold the urine while one person squats on the lower side to observe the source and direction of the urine.
Post-operative soaking of the penis
Potassium permanganate, saline, and boric acid sitz baths can be used after surgery. The purpose of soaking is to promote blood circulation to the wound, promote swelling, softening of the scar and detachment of the stitches. The concentration of potassium permanganate is 1:5000, the color is light pink, use warm water, each sitz bath for 10 minutes, 2-3 times a day. The penis can be bathed or soaked in a small cup. Please note that the soaking time should not be too long because the testicles should not be heated for too long.
One of the post-operative complications: urinary fistula
Urethral fistula is the most common complication after hypospadias. In larger urethral fistulas, all the urine drains through the leak and almost no urine drains from the normal new urethral opening. Some small urethral fistulas will drip out of the leak during urination. Don’t panic if a fistula occurs, as some fistulas can heal on their own. This is especially true for fistulas in the heel of the penis, where there is a lot of tissue, and in the coronal sulcus, where the fistula is not likely to heal on its own because the tissue is very weak.
A small urinary fistula can be treated in this way, especially in the heel of the penis.
1 , sitz bath: potassium permanganate or salt water, see how to soak after surgery. The actual fact is that you will be able to get a lot more than just a few of these.
2, topical cod liver oil: because cod liver oil contains vitamin A, vitamin A has the role of promoting epithelial healing.
3, protect the fistula: every time you urinate, parents are advised to use their fingers to hold the fistula, or clip the fistula, as much as possible to keep urine from flowing out of the fistula, which is also somewhat beneficial to the fistula healing.
4, do not urethral stricture: if the fistula distal urethra urinary pressure is too large, will also bring greater pressure on the fistula, you can ask the doctor to prophylactically dilate the distal urethra, the distal urethra dilated urinary pressure is reduced, conducive to the small fistula healing.
If the fistula does not heal after 1-2 months, there is basically no possibility of self-healing and the surgery will be performed after six months.
Postoperative complication two: diverticulum
Diverticulum is a bulge in the urethra during urination, the urethra stores urine, the urine line is weak during urination, and urine can be ejected by squeezing the bulge after urination. Most of the reasons for diverticula are narrowing of the distal urethra and weakness of the urethral tissue, resulting in increased pressure in the proximal urethra. Early diverticula need to promptly solve the distal stenosis factor, while parents can use their fingers to squeeze the bulge during urination to avoid aggravation of diverticula, if conservative treatment does not work, often need surgery.
Postoperative complication No. 3: Urethral stricture
If a child strains when urinating and has a bowel movement, this is a case of urethral stricture. Or if the child urinates with a line of urine that does not shoot out, but flows weakly from the opening of the urethra and urinates very close together is a precursor of urethral stricture. It is important to seek medical attention when strictures appear. The usual method is urethral dilation, and to enhance the effect of dilation, a urinary catheter can be left in place for a period of time after dilation of the urethra to provide a continuous dilation effect, which also reduces the pain of multiple dilation of the urethra.
It is very important to choose the right hospital and doctor for the first surgery. Choosing an experienced pediatric urologist is the first step towards a successful surgery.
Post-discharge care
After discharge from the hospital, in addition to the above mentioned care and precautions, it is important to protect the affected area from trauma and not to ride a bicycle or a wooden horse for a while. There have been cases of postoperative wound dehiscence due to crawling.