Surgery for Hypospadias in Children

At Hassenfeld Children’s Hospital at NYU Langone, urologists—doctors who specialize in the treatment of congenital urinary tract problems—assess whether surgery is right for your son. Surgery may not be necessary for boys who have mild hypospadias—those with glanular hypospadias and no curvature of the penis. The majority of boys with mild hypospadias experience no related problems, although some parents elect to have surgery performed for cosmetic reasons.

At Hassenfeld Children’s Hospital, surgery for hypospadias is generally performed when a baby boy is six months old. However, the timing depends on the child’s overall health and if the baby was born prematurely. Your child is given general anesthesia by a pediatric anesthesiologist. This is an outpatient surgery with most children returning home that day. The goal of surgery is to correct any curvature of the penis and create an opening of the urethra at the tip of the penis to restore normal function and appearance.

The surgeon straightens the penis, reconstructs the urethra to reach the end of the penis, and provides a circumcised appearance. The doctor places a catheter, which is a thin, flexible tube, in the newly reconstructed urethra to divert urine from the bladder to outside the body and allow the urethra to heal. The stitches from surgery dissolve, so they don’t need to be removed by a doctor.

After surgery, a “sandwich” dressing of bandages pads the penis to protect it. This can help to decrease swelling, which tends to resolve on its own in the following weeks or months. A double-diapering system, in which the catheter diverts urine to the outer diaper, is used to keep urine away from the dressing. During an office visit several days later, your son’s doctor removes the dressing; one week after surgery, the doctor removes the catheter during another office visit.

Rarely, a fistula, which is a tunnel that forms between the urethra and the skin on the penis, can occur after surgery, causing urine to leak. Meatal stenosis, a narrowing of the opening of the urethra can also occur. These may require surgery, which typically takes place six months after the hypospadias surgery.

After surgery, babies may be given an age-appropriate dose of acetaminophen. Most babies who have surgery for hypospadias are prescribed antibiotics to prevent infection and an antispasmodic medication, which suppresses muscle spasms in the bladder that can be caused by the catheter.