Discharge Instructions for Hypospadias Repair with a Stent

Definition of a hypospadias repair with a stent

Hypospadias occurs when the opening (meatus) of the urethra (tube that allowed urine to flow outside the body) is located on the shaft of the penis rather than on the end. This opening can be found anywhere from the end of the penis down to the scrotum. A hypospadias repair moves the meatus to the end of the penis. A stent is a small tube placed in the urethra of the penis to allow urine to pass through and to prevent narrowing of the urethra.

Diet

When can my child eat?
Your child may resume a normal diet after discharge from the hospital.

What should I do about nausea and vomiting?
Below are tips if your child has trouble with nausea and vomiting:

• Let your child’s stomach rest for 30 minutes. Then, return to clear liquids. Clear liquids include Sprite®, apple juice or water.
• When your child can keep clear liquids down, slowly work up to a normal diet.
• Have your child lay down or sit quietly

If the vomiting is persistent or continues, call your child’s care team for next steps.

How will I know if my child is drinking enough?
Dehydration can occur. Signs and symptoms of dehydration include:

• Dry mouth
• Lack of tears
• Not urinating for 6-8 hours or small amount of dark colored urine. Your child should have 6-8 wet diapers per day.

If your child has these symptoms call your doctor or bring your child to the closest emergency room.

Pain

How can I tell if my child is in pain?
Your child’s care team wants your child to be comfortable, although no surgery is pain free. Some children can tell you about their pain. For all children, it is important to offer comfort and listen to their concerns.

Other ways children communicate they are in pain include:

• Moaning
• Whimpering
• Making faces of pain
• Crying
• Irritability
• Being inactive
• Having no appetite
• Not sleeping

How can I tell if my child needs pain medicine or other medicine?
If your child is experiencing pain, you can give them medicine. If it is not time for the medicine, try other ways to control pain such as:

• Watching a favorite show
• Ice packs
• Play games

If these do not work, call your child’s care team to see if changes in the dose or type of medication are needed.

What medicines does my child need?
Acetaminophen alternating with Ibuprofen should be given every 4 hours for the first 24 hours after surgery. These are over the counter medications. Sometimes your doctor will want you to give ibuprofen every 8 hours. Please ask your child’s nurse. Your child does not need to be awakened to keep the dosing schedule.

In addition to over-the-counter medications, your child’s care team may prescribe a stronger medication may be prescribed as needed. If these medications do not help, call your child’s care team and ask to speak to the nurse. If you call outside of normal business hours, call MGfC at 617-726-2000 and ask the operator to page the pediatric urology resident on call.

Bandage/wound care

How should I care for the wound?
Follow the steps below to care for your child’s wound:

1. A small dressing might be wrapped around your child’s penis and taped into position. Remove the dressing 2 days after surgery while your child is in the bathtub.
2. Unwind the gauze over the penis. Just beneath is a clear plastic tape. This may not come off right away. It will fall off easily after soaking the bathtub. If this dressing falls off before the next morning, it is not a problem. Please throw away the gauze and no new dressing is required.
3. After the dressing is removed, apply petroleum jelly to the wound and diaper to prevent sticking to the diaper. The small tube (stent) remains in place and is held there by a stitch in the tip of the penis. The other stitches in the penis will dissolve on their own in 2-4 weeks.

How much drainage is normal?
It is normal to see swelling and bruising around the incision and in the scrotum. A small amount of drainage is also normal. If the incision is dripping blood, apply pressure for 10-15 minutes with a soft, clean cloth and call your child’s care team for next steps. If you cannot stop the bleeding, take your child to the nearest emergency room.

Bathing/showering

When can my child take a bath or shower?
Your child can bathe 2 days after surgery. Place your child in a warm bathtub twice a day for several days. This will help with healing and swelling.

Activity

How active can my child be?
Below are tips on activity levels for your child:

• Do not allow your child to straddle for 2 weeks after surgery. This includes activities such as riding bikes, horseback riding or bouncy balls.
• Anesthesia can make your child feel groggy or sleepy. For the first the day, your child should not do any activities that require balance such as bike riding, playground equipment, scooters, etc. After this, your child can do normal activities safely and carefully.
• Your child can do almost all activities they feel like doing after a hypospadias repair. But they should avoid direct injury to the penis and scrotum.
• It is okay to hold and carry your child as soon as they are released from surgery.
• It is important that you place your child correctly in a car seat after surgery.
• If your child is using a prescription pain medication (such as Oxycodone, Lortab® or hydrocodone), they can become sleepy or dizzy. Watch your child to prevent them from falling.

Behavior

What is normal behavior after surgery?
It is very normal to see behavior changes after surgery. Most changes in behavior only last a few days to 2 weeks. If they last longer than 3-4 weeks, call your child’s care team.

Some examples of changes include:

• Regression (acting like a younger child, such as bedwetting or acting out)
• Changes in sleeping and eating patterns, or nightmares. Being patient with your child will help reduce these changes. Comfort your child and help them feel safe. Understand that your child has been upset by surgery.

What to watch for

Swelling
The penis and scrotum will be quite swollen and bruised. In some cases, the swelling may appear larger on one side. This is expected after surgery.

Fever
Mild fevers after surgery are common. If the fever is above 102° Fahrenheit (38.8° C) for more than 24 hours after surgery, please call your child’s care team and speak to the nurse.

Stent tube
The stent tube is designed to drip continually. With activity, it may squirt as well. If the tube stops dripping and your child is fussy, the tube needs irrigation (cleaning out by a doctor or other medical professional). It is unusual for the tube to need irrigation, but it can happen. Call your child’s care team to make an appointment for irrigation.

If the tube comes out or is pulled out, please call your child’s care team. Ask to speak to the nurse right away. If you call outside of normal business hours, call MGfC at 617-726-2000 and ask to speak to the pediatric urology resident on call.

Bleeding
If the incision is dripping blood, apply pressure for 10-15 minutes with a soft, clean cloth and call your child’s care team for next steps. If you cannot stop the bleeding, take your child to the nearest emergency room.

Whom to call

Please call Pediatric Urology at 617-724-0327 between 8:30 a.m. and 4:30 p.m. Monday through Friday.

If the office is closed, please call MGfC at 617-726-2000. Ask the operator to page the pediatric urology resident on call.

If there is an emergency, go to the nearest emergency room.

Follow-up appointment

The stent tube needs to be removed in 4-7 days. Before you leave the hospital, make a follow-up appointment to have the stent tube removed.

Special instructions

Go to the closest emergency room or call 911 if your child has any of the following signs:

• Chest pain
• Shortness of breath
• Difficulty breathing
• Excessive bleeding
• If you cannot arouse or wake up your child

A note for when you are on the way home…

Observe your child during the ride home. They may sleep but their head and neck should not fall or slump forward. This may cause their airway to become blocked or cause difficulty with breathing. Your child should be in a child safety seat with proper restraints.

Rev. 7/2020. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout. This handout is intended to provide health information so that you can be better informed. It is not a substitute for medical advice and should not be used to treatment of any medical conditions.