54328 1-stage distal hypospadias repair (with or without chordee or circumcision); with extensive dissection to correct chordee and urethroplasty with local skin flaps, skin graft patch, and/or island flap

Name of the Procedure:

1-Stage Distal Hypospadias Repair (With or Without Chordee or Circumcision); Including Extensive Dissection to Correct Chordee and Urethroplasty with Local Skin Flaps, Skin Graft Patch, and/or Island Flap.

Summary

In layman's terms, this procedure repairs a type of birth defect in boys where the opening of the urethra is not at the tip of the penis. The surgery may also address any downward curve of the penis and can include circumcision. The surgeon reconstructs the urethra using skin from the penis and may use grafts from other areas.

Purpose

This procedure addresses hypospadias, a condition where the urethra opens on the underside of the penis rather than at the tip. The goal is to reposition the urethral opening to its correct location, straighten any curvature of the penis (chordee), and often, perform a circumcision.

Indications

• Urethral opening located on the underside of the penis.
• Curvature of the penis (chordee).
• Difficulty with urination or future sexual function.
• Parents’ and pediatrician’s decision to correct hypospadias usually made in infancy or early childhood.

Preparation

• The patient (often an infant) will undergo a physical examination and possibly imaging tests to assess the anatomy.
• Fasting may be required before surgery to ensure an empty stomach.
• Pre-operative instructions will include stopping certain medications and managing underlying health issues.

Procedure Description

1. Anesthesia: The child will be given general anesthesia to ensure they are asleep and pain-free.
2. Incision and Dissection: The surgeon makes precise incisions to access the urethra and correct any curvature (chordee).
3. Urethroplasty: The urethra is reconstructed using local skin flaps or grafts.
4. Closure: The new urethral opening is positioned correctly, and the penile skin is closed. Circumcision may be performed if desired.

Duration

The procedure commonly takes about 2 to 3 hours.

Setting

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

Personnel

• Pediatric Urologist (surgeon)
• Nurses
• Anesthesiologist
• Surgical Technicians

Risks and Complications

• Infection
• Bleeding
• Difficulty urinating immediately after surgery
• Urethral fistula or stricture (narrowing)
• Recurrence of chordee or incomplete correction.

Benefits

• Normalized urination function.
• Improved cosmetic appearance.
• Reduced risk of future sexual dysfunction.
• Resolution of penile curvature.

Recovery

• Post-procedure care includes pain management, usually with oral medications.
• A catheter may be in place temporarily to assist with urination.
• The child will need to avoid rough activities for several weeks.
• Follow-up appointments are essential to monitor healing and surgical success.

Alternatives

• 2-stage hypospadias repair for complex cases.
• Non-surgical management, although generally not recommended.
• Pros of alternatives include potentially fewer surgical risks for minor cases, but cons include less definitive correction.

Patient Experience

• The child will be under anesthesia during the procedure, feeling no pain.
• Post-surgery, discomfort and swelling are common, usually managed with prescribed medications.
• Parents should prepare for several weeks of careful monitoring and follow-up visits.