54324 1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)

Name of the Procedure:

1-stage distal hypospadias repair (with or without chordee or circumcision); with urethroplasty by local skin flaps (e.g., flip-flap, preputial flap).

Summary

This procedure involves repairing the urethra in boys born with hypospadias, a condition where the urethral opening is not located at the tip of the penis but rather along the shaft or base. The procedure uses local skin flaps to reconstruct the urethra, often addressing any associated penile curvature (chordee) and performing circumcision if needed.

Purpose

The procedure addresses hypospadias, aiming to create a functionally normal urethra and penis. The expected outcomes include the ability to urinate in a normal stream, improved cosmetic appearance, and correction of penile curvature if present.

Indications

• Presence of distal hypospadias.
• Symptoms include abnormal urine stream, difficulty with urination, or cosmetic concerns.
• Indicated for infants and young boys who fulfill surgical criteria based on the severity of the condition.

Preparation

• Patients typically need to fast for 6-8 hours before surgery.
• Pre-operative assessments may include urinalysis and blood tests.
• Parents may need to discuss any medications the child is taking with the surgical team.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the child is asleep and pain-free.
2. Incision and Mobilization: An incision is made to access the urethral opening; any chordee is released if present.
3. Urethroplasty: Using local skin flaps (e.g., flip-flap or preputial flap), the surgeon reconstructs the urethra to create a new, functionally and anatomically correct urethral tube.
4. Closure: The incisions are closed with dissolvable stitches.
5. Circumcision (if needed): The foreskin is removed as part of the repair process.

Duration

The procedure typically takes 1 to 2 hours, depending on complexity.

Setting

It is performed in a surgical center or hospital setting, often on an outpatient basis.

Personnel

• Pediatric urologic surgeon.
• Surgical nurses.
• Anesthesiologist.
• Possibly a pediatrician for pre-operative evaluation.

Risks and Complications

• Common risks: Infection, bleeding, swelling.
• Rare risks: Urethral fistula, strictures, or diverticulum formation.
• Complication management may involve medications or additional corrective procedures.

Benefits

• Corrects the position of the urethral opening.
• Allows for normal urination and improves cosmetic appearance.
• Most benefits are realized immediately, with full healing typically achieved in a few weeks.

Recovery

• Post-operation care includes pain management and keeping the area clean.
• Activity restrictions for a couple of weeks.
• Follow-up appointments to monitor healing.
• Urinary catheter may be placed temporarily.

Alternatives

• Delayed or staged repair if the child is very young or the condition is more complex.
• Conservative management in mild cases, with surgery deferred until later.
• Each alternative has its own risks and benefits, with staged repairs potentially involving multiple procedures.

Patient Experience

• The child will be under anesthesia during the procedure and won't feel pain.
• Some discomfort or swelling after the surgery, managed with pain relief medications.
• Parents are typically instructed on care and monitoring for any signs of complications at home.