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Genitals

Hypospadias surgery: how it is done and what happens next

Stages of hypospadias surgery, one- or two-stage repair, catheter, dressing, home care, possible complications and follow-up.

Written by: Dr. Parviz Hajiyev, pediatric urologist.

Quick answers

Best age
6–18 months.
Duration
1.5–3 hours.
Catheter
Usually 5–10 days.
Success
About 90–95% in distal hypospadias.

Goals of the operation

  1. To straighten the penis.
  2. To create a new urinary channel and bring the urinary opening to the tip of the head of the penis.
  3. To give the head of the penis a normal shape.
  4. To cover the penis with skin, and to restore the foreskin when possible or to circumcise.

More about the condition: hypospadias.

Methods

  • One-stage operation. For distal and midshaft hypospadias, the TIP (Snodgrass) method is used most often: the tissue plate below the urinary opening is incised down the middle to widen it and then stitched into a tube. The new channel is covered with an extra layer of tissue to lower the risk of a fistula.
  • Two-stage operation. For severe proximal hypospadias and marked curvature: in the first stage, the penis is straightened and the foreskin is moved to where it will be needed for the new channel; 6 months later, in the second stage, the channel is formed.

Day of surgery and after

  • General anesthesia with local anesthesia.
  • A thin silicone catheter is placed inside the new channel, and the penis is wrapped in a soft dressing.
  • In distal cases, children usually go home the same day or the next day.

Home care

  • Double diaper: the catheter is passed through the inner diaper and out into the outer diaper.
  • The dressing usually stays on for 2–5 days, the catheter for 5–10 days.
  • An antibiotic and a medicine for bladder spasms may be prescribed.
  • The catheter must not get blocked: give your child plenty of fluids.
  • After the dressing is removed, a short warm bath 1–2 times a day.
  • No straddle toys for 2–3 weeks.

In the first weeks, swelling, bruising and mild burning when passing urine are normal.

Possible complications

  • Fistula: a small hole in the new channel, so urine comes out from two places.
  • Narrowing of the urinary opening: a thin, straining stream.
  • Widening of the channel (diverticulum).
  • Separation of the stitches on the head of the penis.
  • Residual curvature.

Most are corrected 6 months later with a second, smaller operation.

Follow-up

After the catheter is removed, the child is examined at 1, 3–6 and 12 months, and then after toilet training. If possible, follow-up continues until adolescence, because some problems only show up as the child grows.

When to seek urgent care

If any of the following is present, do not wait for a routine appointment: call the doctor or go to the nearest emergency department.

  • Catheter blocked or out, no urine coming
  • Bleeding that soaks the dressing
  • Fever above 38.5°C, foul-smelling discharge
  • Darkening of the head of the penis

Note for pediatricians and family doctors

For distal hypospadias, TIP (Snodgrass) urethroplasty is used most often; for proximal forms and severe curvature, a two-stage (Bracka) approach is preferred. The most common complications are urethrocutaneous fistula, meatal stenosis, diverticulum and glans dehiscence. Children should be followed after toilet training and until puberty, because some complications and curvature are detected late.

What happens at the visit?

  1. Before surgery, the type of hypospadias, the curvature and the size of the head of the penis are assessed.
  2. If the head of the penis is small, a short course of hormone treatment before surgery may be discussed.
  3. After surgery, written instructions are given about the catheter, dressing, double diaper and medicines.
  4. A follow-up visit is scheduled to remove the dressing and catheter.
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Frequently asked questions

How will my child manage at home with a catheter?

The catheter drains urine straight into the diaper. With the double-diaper method, the catheter passes through the inner diaper into the outer diaper, so the wound stays dry. Your child can play, eat and sleep, and only needs to avoid straddle toys.

What should the urine stream look like after surgery?

After the catheter is removed, urine should come from the tip of the penis in a straight, single stream. If urine comes out from two places, this is a sign of a small hole (fistula); let your doctor know.

Related topics

Sources

  • EAU Guidelines on Paediatric Urology, 2025: Hypospadias.
  • Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol, 1994.

This page is for education. Decisions about your child’s treatment are made together with the doctor after an examination.

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