1.Activity
Encourage the patient to move around normally will not affect the wound healing, but also help to improve the comfort of the child, and pay attention to the protection of the catheter during the activity. In particular, long-term bed rest is not recommended, because bed rest is not on the ground, the penis is facing upward, which is not conducive to the flow of secretions, which can easily lead to infection. Parents should not show tension and anxiety in front of the child, which is not conducive to the physical and mental health of the child.
2.Medication
Take drugs according to medical advice. The purpose of antibiotics is mainly to prevent urethral and wound infections during the catheterization period, and take medication until 2-3 days after the catheter is removed. Generally, children who have the first surgery do not need long-term intravenous rehydration, and oral administration is sufficient. For reoperations, especially with poor local tissue conditions, continuous intravenous broad-spectrum antibiotics are required. Individuals with poor penile development need to use drugs to improve penile development after surgery.
3.Diet
There is no special contraindication to diet. Drink more water including beverages during the period with the tube to keep urine full. The diet should be easy to digest and highly nutritious, with appropriate supplementation of fruits, vegetables and coarse fiber foods to keep the bowel movement smooth and effortless. If the stool is hard to pass, you can use corky or laxative medicine. If the stool stains the wound, it needs to be removed in time. 2-3 days after surgery, no bowel movement, you need to use laxative drugs in time to avoid postoperative bleeding due to straining of stool.
4.Catheter
Keep the catheter unobstructed. During the period with the catheter, the color of urine is red, a small amount of blood oozes from the urethral opening, a small amount of fluid oozes from the drainage tube, or urine flows out from the urethral opening next to the catheter is a normal postoperative phenomenon, if the urine continues to be bright red, there is continuous blood oozing from the urethral opening, and the daily drainage flow from the drainage tube is high or bright red and purulent in color, timely medical consultation is required. The catheter is usually removed 2-3 weeks after surgery depending on the surgical approach. For the scrotal drainage tube left in the hospital at the time of discharge, the distal type of hypospadias is usually removed 3-5 days after surgery, and the proximal type may need to be kept until 2-3 days after removal of the catheter, depending on the urination situation. The wound with the drainage tube removed will generally heal on its own within 2-3 days and does not need to be closed with sutures again.
5.Wound care
Keep the surgical wound dry and clean and urethral opening clean 2 times a day (one in the morning and one in the evening), available wet tissue or wet cotton swab wipe, if the skin is wet available electric hair dryer will blow dry nearby, but must pay attention to the temperature, beware of burns! When wiping, pay special attention to the skin folds, such as the root of the penis, the skin needs to be spread flat and then wipe these folds clean. A small amount of ophthalmic ointment of gentamycin can be applied to the skin folds such as the urethral opening of the head of the penis, the penile body wound and the root of the penis to prevent adhesion of underwear and diapers. You can take a shower 1 week after surgery, and you can also take a shower with a urinary catheter. You are encouraged to rinse the whole penis with water, and you can also use shower gel and shampoo as usual to help remove skin exudates and crusts, especially in the hot season. After the shower, wipe the perineum and the wound clean or dry it with a hair dryer. In short, keep the wound dry and clean. If there is vesicles, rupture, pus, darkening of the skin or odor at the wound, you should come to the hospital promptly. Generally 1-2 showers a day is enough, after the completion of cleaning, you can apply disinfectant to prevent infection, you need to pay attention to the concentration of disinfectant, general iodophor needs to be half diluted.
6.Sutures and auxiliary materials
Surgical sutures are absorbable sutures, which will gradually fall off on their own after about one month after surgery, so there is no need to remove the sutures and avoid pulling. If you feel uncomfortable with the sutures, you can use small scissors to cut them short 2 weeks after surgery to facilitate their removal. After surgery, the surgeon will generally continue to bandage the wound for a few days according to the operation, which is not regardless of, or without looking at the wound. The continuous pressure bandaging in the first few days after surgery is crucial to control bleeding and prevent edema. For patients who still have gauze or elastic bandage dressing at the time of discharge, the dressing needs to be removed at the outpatient clinic within 3-5 days after discharge, or as prescribed by the doctor. In order to fix the urinary catheter and prevent it from falling off and slipping out, we will fix the urinary catheter at the head of the penis with sutures, do not handle it without permission.
7.Bladder spasm
During the period of indwelling catheterization, the child experiences paroxysmal lower abdominal pain and discomfort in the anal area, which can also be manifested as having urine coming out of the urethra instead of the urethra. In particular, the child may feel a sudden burst of pain and a severe urge to urinate, followed by a jet of urine around the urethra, with little urine coming out of the urethra. This is usually caused by the irritation of the bladder triangle by the catheter, and will disappear naturally after the catheter is removed.
Treatment.
1.Check whether there is folding of the catheter, poor drainage, whether the tube has slipped out and changed position compared to the postoperative period.
2.Put hot wet towel on the lower abdomen to relieve the symptoms.
3.If the position of the tube changes significantly or slips out, the tube needs to be adjusted and put in a little; if the position of the tube is normal, but the symptoms continue to be unrelieved or occur frequently, you need to come to the hospital for consultation.
4.Urine flowing out from the urethra during the period with the tube will generally not affect the effect of the procedure and need not be overly worried.
8.Urinary discharge
In the initial-2 days after the tube is removed, stinging urination and discomfort are normal, or encourage urination. If there is thinning of the urine line, straining to urinate (especially if there is a bowel discharge during urination), urine flowing from a place other than the urethral orifice during urination or a bulging lump on the ventral side of the penis during urination, it is necessary to come to the hospital promptly.
9.Oedema
Within 1 week after surgery, edema is a completely normal reaction and there is no need to worry about it. 2 weeks or less, edema will gradually subside, and 3-6 weeks after surgery, it will tend to stabilize. If the edema is obvious after surgery, you can apply pressure bandage, external concentrated sodium saline, shower and bath to help accelerate the edema decreasing.
10.Repeat consultation
The planned postoperative follow-up time is according to the discharge medical advice, and you must bring the discharge summary to the follow-up. Other individual or special cases are subject to doctor’s orders.
11.Adult patients should avoid sexual life for 6 weeks after surgery.