Name of the Procedure:

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

Summary

Urethroplasty for second stage hypospadias repair is a surgical procedure aimed at correcting complex forms of hypospadias, a congenital condition where the opening of the urethra is not located at the tip of the penis. This particular procedure addresses cases where the urethral defect is longer than 3 cm and requires urinary diversion.

Purpose

The procedure is designed to correct congenital hypospadias, allowing for normal urination and function. The main goals are to reconstruct the urethra, improve cosmetic appearance, and prevent any potential complications associated with untreated hypospadias, such as urinary tract infections or difficulties with urination.

Indications

• Patients with complex hypospadias, especially those with severe curvature or extensive urethral defects.
• Persistent issues following initial repair attempts.
• Symptoms including difficulty urinating or abnormal urine stream.

Preparation

• Fasting for 6-8 hours prior to surgery.
• Temporarily stopping certain medications as advised by the doctor.
• Preoperative assessment including blood tests, urinalysis, and possibly imaging studies like ultrasound or MRI.

Procedure Description

1. Anesthesia: The procedure is performed under general anesthesia.
2. Incision: An incision is made at the site of the previous repair.
3. Tissue Harvesting: Tissue, often from the buccal mucosa (inside of the cheek), may be harvested for grafting.
4. Grafting: The harvested tissue is used to reconstruct the urethra over a stent or catheter.
5. Urinary Diversion: A diversion, such as a suprapubic catheter, is placed to allow urine to drain while the new urethra heals.
6. Closure: The incision is closed with sutures.
7. Assessment: The surgical site is assessed for proper alignment and vascularization.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

The procedure is performed in a hospital or specialized surgical center equipped with facilities to manage complex pediatric urological surgeries.

Personnel

• Pediatric urologist or specialized urologic surgeon.
• Anesthesiologist.
• Surgical nurses.
• Operating room technician.

Risks and Complications

• Infection.
• Bleeding.
• Urethral stricture (narrowing).
• Fistula formation (abnormal connection between urethra and skin).
• Anesthetic complications.

Benefits

• Restoration of normal urinary function.
• Improved cosmetic appearance.
• Reduced risk of future urinary tract infections.
• Overall better quality of life.

Recovery

• Hospital stay for 2-3 days post-operation.
• Pain management with prescribed medications.
• Avoidance of vigorous activities for several weeks.
• Regular follow-up appointments to monitor healing.
• Removal of urinary diversion after 2-4 weeks, depending on healing progress.

Alternatives

• First-stage hypospadias repair (if not already attempted).
• Use of alternative tissue grafts.
• Conservative management for less severe cases.
• Phalloplasty for highly complex or recurrent cases.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, mild to moderate pain is common and managed with medications. Discomfort from the urinary catheter or stent may be experienced, and the patient might require help with urination until the follow-up appointments and removal of the catheter. Regular check-ups are necessary to ensure proper healing and functionality.