Hypospadias Surgery In Delhi

1. Hypospadias Surgery InDelhi • What ishypospadias? • Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis. In boys with hypospadias, the urethra forms abnormally during 8-14 weeks of pregnancy. The abnormal opening can be anywhere, from just below the end of the penis to the scrotum. Depending on the site of the opening they are classified as distal (minor type)and proximal (majortype). • Types ofHypospadias: • The types of hypospadias a boys has depends on location of the opening of theurethra: • Subcoronal: The opening of the urethra is located somewhere near the head of thepenis. • Midshaft: The opening of the urethra is located along the shaft of thepenis. • Penoscrotal: The opening of the urethra is located where the penis and scrotummeet. • Understanding the normal penis and urethra • The normal urethra is a tube through which that urine flows out of the bladder. It passes through the penis. The opening of the urethra (meatus) is normally at the end of the penis, partly covered by theforeskin. • What is the penis like inhypospadias? • The main problem is that the urethra opens on the underside of the penis instead of at the end of the penis. The opening can be anywhere from just below the normal position (mild) to as far back as the base of the scrotum (severe). • Hypospadias may also include thefollowing: • A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis. • Tightening of the tissues on the underside of the penis (called ‘chordee’). This pulls the penis down andit • cannot fully straighten. This is commanly seen in severehypospedias • What problems can hypospadiascause? • Problems are likely to occur if hypospadias is left untreated. The further back the opening of the urethra is, the more severe the problems are likely tobe. • Passing urine is different to normal. A baby in nappies will have no problem. However, when older, the urine stream may not be able to be directed forward into a urinal. When going to the toilet the urine is likely to ‘spray’ backwards. Sitting on a toilet may be needed to pass urine withoutmess. • Chordee causes bending of the penis. This is more noticeable when the penis is erect. Sexual intercourse may be difficult or impossible in severecases. • Psychological problems about being ‘different’ to normal arecommon.

2. How common is hypospadias and what causesit? • About 1 in 300 boys are born with some degree of hypospadias. It seems to be getting more common. The reason why the penis does not develop properly is still not clear. The development of the penis while the baby is growing in the womb (uterus) is partly dependent on the male sex hormones such astestosterone. • What is the treatment forhypospadias? • If the hypospadias is mild, with the opening of the urethra just a little down from normal and with no bending of the penis, no treatment may be needed. However, in most cases an operation is required tocorrect • the hypospadias. This can usually be done in one operation. However, if the hypospadias is more complicated, two operations may be necessary. The operation is usually done when the child is around 6-18 months old. The goals of treatment are: • For urine to be passed in a forwardway. • For the penis to be straight whenerect. • For the penis to look as normal aspossible. • The position of the opening of the urethra is altered. Also, if chordee is present then this is corrected to allow the penis to straighten. The foreskin is usually used during the operation to make the new urethra so it is important that a circumcision is not done before the corrective surgery is performed.depanding on the surgery of hypospediassurgeryes • The success of the operation and the ‘normality’ that can be achieved depends on the severityof • the hypospadias done in single as twostage • What happens after the operation? • Your son will be brought back to the ward to recover. He will be able to eat and drink after 3 hours He will have a dressing on his penis and a tube draining away the urine. The patients are usually kept for 2 days in the hosptial and then discharged. The dressing and tube need to stay in place for 10 days, then you will need to come back to the Hospital to have themremoved. • What are the risks of hypospadiasrepair? • All surgery carries a small risk of bleeding during or after theoperation. • For about one in ten boys, the original hole opens up again, so that your son passes urine through two holes. This can occur at any time after the operation. If this happens, your son will need the operation again. Occasionally, the new hole at the tip of the penis is too small, so your son will need another operation to make the hole larger. The drainage tube can irritate the inside of the bladder, which is painful. This is called ‘bladder spasm’. To reduce this, your son will be given ‘bladder spasm medicine’ as well as painrelief. • When you gethome • Your son will go home with the catheter and dressing in place. Staff on the ward will give you full details of how to care for these at home. • You should encourage, to drink plenty ofwater/fluids. • Your child may need some pain relief when you gethome. • You should not have a bath or shower until after the dressing comesoff. • Putting your son in two nappies at a time can protect the area from accidentalknocks. • Your son should not ride a bicycle or any sit-on toy until the area hashealed.

3. Try to avoid getting the dressing dirty when nappy changing. If this happens, dab any faeces off with a damp cloth. • As there is a small risk of infection, your son will need to take antibiotics until he returns for his outpatient appointment. • Post OpTeaching • Case ofcethetea • How to empty urinebag • How to avoid kinking, twisting, blockage of catheter orstent • May empty straight intonappy • How to tape drainage bag to leg allowing a child to bemobile • Never clamp off catheter • Child encouraged to increase fluidintake • Twice daily sponging recommended and looseclothing • No outdooractivity • You shouldcontect: • your child is in a lot of pain and pain relief does not seem tohelp • there is any oozing from thewound • the dressing falls off/becomeswet • the tube stops or reduces the amount of urine draining from it or the tube fallsout • What happensnext? • You will be called for dressing as per instructions given in discharge summary. This can be painful, so before hand make sure that your son has the maximum dose of pain relief possible but no bladder spasm medicine. When the dressing has been removed, the penis will look red and swollen. This is normal and will settle down within a few days. Tags = best pediatric urologist in delhi, best pediatric urologist in india, best pediatric surgeon in delhi, best pediatric surgeon inindia