Distal Hypospadia Repair

Why is it done?

• To treat a congenital birth defect where the urethral meatus has an abnormal opening at the ventral aspect of the corona or distal penile shaft.
• Usually no penile chordee associated.
• May have a Doral cap of foreskin, or could be completely normal.
• Usually in kids (neonates), occasionally picked up in older kids and seldomly in adults.

Pre-requirements

• An informed consent is required from the patient / parents.
• Patients may not eat or drink from 6-8 hours prior to surgery according to age.
• Adult patients are to refrain from smoking before the procedure.
• Patients allergic to IODINE / CHLORHEXIDINE should clearly state this at the Pre-admission clinic as well as to theatre staff and Dr Schoeman.
• Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. Clexane injections may be substituted.
• Patients with cardiac illnesses require a ardiologist / physician’s report.
• A chest X-ray is required for patients with lung disease.
• Pre-op blood tests are required 4 days prior to surgery.
• Be prepared for an overnight stay.

How is it done?

• • This procedure is done under general anaesthetic.
  • Supine position.
  • A Snodgrass procedure is usually done, or alternatively a Meatal Advancement technique.
  • A single incision is made on the midline of the urethral plate slitting it in two.
  • The wings of the glans are mobilised.
  • The urethra plate is closed ventrally over an indwelling catheter which is fixed temporarily at this site.

• Supportive subcutaneous tissue from the foreskin is brought ventrally on a vascular pedicle and laid over the urethral sutures.
• Skins is closed over and the rest of the wound by splitting the dorsla foreskin and bringing it ventral.
• Excess skin is not trimmed in case it is needed for a subsequent procedure.
• The stricture is excised with a spatulated anastomosis over an Indwelling Catheter.
• A long-term catheter will be inserted for 10 days.
• A dressing is then applied, which should be removed after 72 hours.
• A local anaesthetic is injected at the base of the penis as a penile block thus giving post-operative pain relief for the next 4-6 hours.
• Keep in mind the procedure is not always successful.

What to expect after the procedure?

• Any anaesthetic has its risks and the anaesthetist will explain all such risks.
• You will be sent home with an Indwelling catheter for 7-10 days.
• Bleeding is a common complication.
• A haematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
• Necrosis of the skin edges can occur and cause a skin defect.
• Small skin defects will heal over, larger defects may require skin graft.
• A fistula (urine leak between urethra and skin) can occur and will require delayed closure.
• An infection of the wound may occur and requires immediate attention.
• Stricturing of the meatus may occur.
• Owing to the area of the surgery the wound should be kept clean and dry.

What next?

• The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until it comes off easily.
• The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
• On discharge a prescription may be issued for patients to collect.
• Arrangements will be made for the removal of the catheter after 7-10 days.
• A review within 6 weeks to determine the final result of the surgery
• There will be signs of bruising for at least 10 days.
• The suture-line will be hard and indurated for at least 8-10 weeks.
• Please direct all further queries to Dr Schoeman’s Rooms.
• PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Distal Hypospadias Repair