Hypospadias Surgery in Infants
Quick Answer: What is Hypospadias and When Should Surgery Be Done?
Hypospadias is a common birth defect where the urinary opening is not at the tip of the penis. Surgery to correct this is typically done between 6-18 months of age and has excellent success rates. If your baby boy has hypospadias, don’t worry - it’s correctable and your child can have completely normal urinary and sexual function after repair.
Reassurance: Hypospadias is more common than you might think (affects about 1 in 200-300 boys). With modern surgical techniques, outcomes are excellent!
What is Hypospadias?
In hypospadias, the opening of the urethra (where urine comes out) is located on the underside of the penis instead of at the tip. It can range from mild to severe:
| Type | Location of Opening | Severity |
|---|---|---|
| Distal/Glanular | Near tip but not at tip | Mild |
| Midshaft | Middle of penis | Moderate |
| Proximal/Penoscrotal | Near scrotum | Severe |
Associated Features
- Chordee: Downward curve of penis (common with hypospadias)
- Hooded foreskin: Incomplete foreskin on underside
- Undescended testis: May occur together
Why Does Hypospadias Happen?
The exact cause is often unknown, but may include:
- Hormonal factors during pregnancy
- Genetic factors (can run in families)
- Environmental factors
- Maternal use of certain medications during pregnancy Important: It’s NOT caused by anything the mother did wrong. It happens during fetal development.
When Should Surgery Be Done?
| Age | Recommendation |
|---|---|
| Best time | 6-18 months |
| Acceptable | Up to 3 years |
| Still possible | Any age, but better when younger |
Why This Age?
- Baby has grown enough for surgery
- Before toilet training
- Before child is aware of the difference
- Better healing in young children
- Less psychological impact
What Happens During Surgery?
The surgery corrects:
- Position of urinary opening - Moved to tip of penis
- Chordee - Straightens the curved penis
- Foreskin - Reconstructed or removed
Key Points
- Done under general anesthesia
- Usually takes 1-3 hours depending on severity
- Often done as day surgery (go home same day)
- Sometimes needs 2 stages for severe cases
- Catheter may be placed for 1-2 weeks
Post-Surgery Care
First 24-48 Hours
- Baby may be fussy due to discomfort
- Give pain medication as prescribed
- Keep diaper area dry
- Double diapering for extra protection
Caring for the Surgical Site
- Don’t remove dressing unless instructed
- Keep area clean
- Apply antibiotic ointment if prescribed
- No baths until surgeon allows (usually 3-5 days)
- Pat dry gently
Managing Pain
Use paracetamol (Calpol) for pain and any fever:
| Baby’s Weight | Calpol Drops (100mg/ml) | Calpol Syrup (120mg/5ml) |
|---|---|---|
| 5-6 kg | 0.5-0.6 ml | 2.5 ml |
| 6-8 kg | 0.6-0.8 ml | 3-4 ml |
| 8-10 kg | 0.8-1 ml | 4-5 ml |
| 10-12 kg | - | 5-6 ml |
Give every 4-6 hours as needed. Max 4 doses in 24 hours.
When to Worry After Surgery
Call Surgeon IMMEDIATELY if:
- Fever above 102°F (38.9°C) lasting more than 24 hours
- Blue or grey color at tip of penis
- Bleeding at surgical site
- No urination for 8+ hours
- Catheter falls out (if one was placed)
- Extreme pain despite medication
- Signs of infection (pus, increasing redness, swelling)
Normal Post-Surgery Signs
- Mild swelling (1-2 weeks)
- Bruising (1-2 weeks)
- Some fussiness (few days)
- Blood-tinged urine initially
Recovery Timeline
| Time | What to Expect |
|---|---|
| Day 1-3 | Most discomfort, fussy baby |
| Day 3-7 | Improving, less pain medication needed |
| Week 1-2 | Catheter removal (if placed) |
| Week 2-4 | Swelling resolving |
| 2-3 months | Mostly healed |
| 6 months | Full healing complete |
Activity Restrictions After Surgery
| Activity | When to Resume |
|---|---|
| Normal diaper changes | Immediately (be gentle) |
| Bathing | 3-5 days (surgeon’s guidance) |
| Sitting toys (walkers, etc.) | 4-6 weeks |
| Swimming | 6-8 weeks |
| Normal play | 2-4 weeks |
Potential Complications
Most surgeries are successful, but possible complications include:
| Complication | What It Is | Solution |
|---|---|---|
| Fistula | Abnormal opening develops | May need minor repair surgery |
| Stricture | Scar tissue narrows urethra | May need dilation or surgery |
| Breakdown | Part of repair fails | May need revision surgery |
| Infection | Surgical site infection | Antibiotics |
Note: Complications are uncommon with experienced pediatric urologists.
Long-Term Outlook
With successful surgery:
- Normal urination (standing up)
- Normal sexual function in adulthood
- Normal appearance
- No issues with fertility Regular follow-up with urologist is important for first few years.
Expert Insight: As our doctors say, ‘Focus on how your child looks and acts, not just the number on the thermometer.‘
FAQs
Q: My baby has mild hypospadias. Does he really need surgery?
A: Even mild hypospadias is usually repaired to ensure normal urine stream direction (important for standing urination), cosmetic appearance, and prevent potential issues with sexual function later. Discuss with a pediatric urologist.
Q: Baby has fever 101°F after hypospadias surgery. What should I do?
A: Low-grade fever (up to 101°F) in first 24-48 hours after surgery can be normal. Give Calpol for comfort (dose by weight). If fever is above 102°F, lasts more than 24 hours, or baby seems very unwell, contact your surgeon immediately.
Q: Should we get our baby circumcised if he has hypospadias?
A: NO! If hypospadias is present, circumcision should NOT be done. The foreskin tissue is often needed for surgical repair. Always inform the doctor about hypospadias before any procedure.
Q: How much does hypospadias surgery cost in India?
A: Costs vary widely based on hospital, surgeon, and severity. Generally ranges from Rs. 40,000 to Rs. 2,00,000 in private hospitals. Government hospitals offer subsidized or free treatment.
Q: Will my son remember the surgery?
A: Surgery done between 6-18 months is recommended partly because children don’t form lasting memories at this age. He will have no psychological trauma from the procedure.
Q: Can hypospadias recur after surgery?
A: Once properly repaired, hypospadias doesn’t recur. However, complications like fistula may need additional surgery in some cases. Regular follow-up ensures any issues are caught early.
This article was reviewed by a pediatrician. Last updated: January 2025
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