Name of the Procedure:

Urethroplasty for Second Stage Hypospadias Repair (including urinary diversion); <3 cm

Summary

Urethroplasty for second stage hypospadias repair is a surgical procedure to correct the urethra in males born with hypospadias, a condition where the opening of the urethra is not located at the tip of the penis. This second stage of repair focuses on completing the reconstruction, often using tissue grafts, and may involve a temporary urinary diversion.

Purpose

This procedure addresses the congenital condition of hypospadias to create a normally functioning urethra and to ensure the urinary opening is correctly positioned. The goal is to restore normal urine flow and improve cosmetic appearance.

Indications

• Congenital hypospadias with incomplete primary repair
• Persistent abnormality in the urethral opening
• Presence of urinary fistulas or strictures
• Patient's urethral issues persisting after initial surgery

Preparation

• Patient may be instructed to fast for several hours before the procedure.
• Pre-operative assessments including blood tests and imaging studies might be required.
• Review of current medications and possible adjustments, especially blood thinners.
• An informed consent discussion regarding the procedure and its risks.

Procedure Description

1. Anesthesia is administered to ensure the patient is unconscious and pain-free.
2. The surgical area is sterilized, and an incision is made to access the urethra.
3. Scar tissue from previous surgery may be removed.
4. Using tissue grafts (often from the foreskin or mucosal lining), the surgeon reconstructs the urethral channel, ensuring it is less than 3 cm in length.
5. A stent or catheter may be temporarily placed to ensure proper urine flow during healing.
6. The incision is closed, and the patient is awakened from anesthesia.

Tools and equipment: Scalpels, fine suturing materials, catheters, and grafting tissue instruments.

Duration

The procedure typically takes 1-2 hours.

Setting

Performed in a hospital or surgical center under sterile conditions.

Personnel

• Pediatric or specialized urological surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding and hematoma formation
• Urethral fistula formation (an abnormal connection)
• Stricture (narrowing of the urethra)
• Compromised healing of grafts
• Recurrence of hypospadias

Benefits

• Restoration of normal urinary function
• Improved cosmetic appearance of the genitalia
• Reduced risk of future urinary tract infections
• Improved quality of life

Benefits are typically realized within a few weeks post-surgery once healing has commenced.

Recovery

• Might require a hospital stay of 1-2 days.
• Pain medication and antibiotics may be prescribed.
• Avoid strenuous activities and follow specific instructions on catheter care.
• Regular follow-up appointments to ensure proper healing.
• Expected full recovery time is 4-6 weeks.

Alternatives

• One-stage hypospadias repair
• Ongoing non-surgical management (e.g., urinary diversion techniques)
• Consideration of risks and benefits; alternative methods may not provide the same functional or cosmetic improvements.

Patient Experience

During the procedure, the patient will be under general anesthesia and not feel pain. Post-operatively, there could be some pain and discomfort managed through prescribed pain relief measures. There may also be the temporary inconvenience of a urinary catheter. Follow the doctor's instructions to ease recovery and manage pain.