Name of the Procedure:

Urethroplasty for Second Stage Hypospadias Repair (with Urinary Diversion) using Free Skin Graft (Non-Genital)

Summary

This procedure is a surgical repair for hypospadias, a birth defect affecting the urethra in males. This second-stage operation involves creating or reconstructing the urethra using a skin graft from a part of the body other than the genital area, along with a temporary urinary diversion to aid healing.

Purpose

The primary aim is to correct hypospadias, which is a condition where the urethral opening is not located at the tip of the penis. The procedure helps achieve normal urination, improved cosmetic appearance, and better sexual function.

Indications

• Presence of hypospadias uncorrected by an initial surgery
• Urethral stricture or fistula
• Difficulty in urination
• Adverse healing from a previous hypospadias repair

Preparation

• Patients may need to fast for a specific period before surgery.
• Pre-operative blood tests, urinalysis, and imaging studies might be required.
• Adjustment or cessation of certain medications as advised by the surgeon.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made in the penile area to expose the urethra.
3. Graft Harvesting: A free skin graft is obtained from a non-genital area, such as the inner arm or thigh.
4. Urethroplasty: The harvested graft is used to reconstruct or create the new urethra.
5. Urinary Diversion: A catheter or stent is placed to divert urine flow temporarily, allowing the new urethral segment to heal properly.
6. Closure: The incision sites are closed with sutures.

Duration

The procedure typically takes 3 to 5 hours, depending on the complexity.

Setting

The surgery is performed in a hospital operating room or a specialized surgical center.

Personnel

• Urologist or pediatric surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Graft failure or rejection
• Urethral stricture or fistula recurrence
• Anesthetic complications

Benefits

• Restoration of normal urination
• Improved cosmetic appearance
• Enhanced sexual function
• Relief from symptoms causing discomfort or inconvenience

Recovery

• Hospital stay for a few days post-surgery for monitoring
• Pain management with prescribed medications
• Instructions for catheter care and hygiene
• Limit physical activity for several weeks
• Follow-up appointments for suture removal and assessment of healing

Alternatives

• First-stage urethroplasty (if not already performed)
• Perineal urethrostomy (an alternative urinary tract reconstruction)
• Watchful waiting (if symptoms are mild and manageable)

Patient Experience

• During the procedure: Patient will be under general anesthesia and unconscious.
• After the procedure: Some pain and discomfort at the incision site, managed with medications. Urinary catheter will cause some inconvenience until removed. Regular follow-up visits to ensure satisfactory healing.

For more detailed information and personalized guidance, always consult with the healthcare provider performing the procedure.