Quick Answer: What is Hypospadias and When Should Surgery Be Done?
Hypospadias is a common birth defect where the urinary opening is not at the tip of the penis. Surgery to correct this is typically done between 6-18 months of age and has high success rates. If your baby boy has hypospadias, it is correctable, and most children go on to have good urinary and sexual function after repair.
Reassurance: Hypospadias is more common than you might think (affects roughly 1 in 200-300 boys). With modern surgical techniques, outcomes are generally very good.
What is Hypospadias?
In hypospadias, the opening of the urethra (where urine comes out) is located on the underside of the penis instead of at the tip. It can range from mild to severe:
| Type | Location of Opening | Severity |
|---|---|---|
| Distal/Glanular | Near tip but not at tip | Mild |
| Midshaft | Middle of penis | Moderate |
| Proximal/Penoscrotal | Near scrotum | Severe |
Associated Features
- Chordee: Downward curve of penis (common with hypospadias)
- Hooded foreskin: Incomplete foreskin on underside
- Undescended testis: May occur together
Why Does Hypospadias Happen?
The exact cause is often unknown, but may include:
- Hormonal factors during pregnancy
- Genetic factors (can run in families)
- Environmental factors
- Maternal use of certain medications during pregnancy Important: It’s NOT caused by anything the mother did wrong. It happens during fetal development.
When Should Surgery Be Done?
| Age | Recommendation |
|---|---|
| Best time | 6-18 months |
| Acceptable | Up to 3 years |
| Still possible | Any age, but better when younger |
Why This Age?
- Baby has grown enough for surgery
- Before toilet training
- Before child is aware of the difference
- Better healing in young children
- Less psychological impact
What Happens During Surgery?
The surgery corrects:
- Position of urinary opening - Moved to tip of penis
- Chordee - Straightens the curved penis
- Foreskin - Reconstructed or removed
Key Points
- Done under general anesthesia
- Usually takes 1-3 hours depending on severity
- Often done as day surgery (go home same day)
- Sometimes needs 2 stages for severe cases
- Catheter may be placed for 1-2 weeks
Post-Surgery Care
First 24-48 Hours
- Baby may be fussy due to discomfort
- Give pain medication as prescribed
- Keep diaper area dry
- Double diapering for extra protection
Caring for the Surgical Site
- Don’t remove dressing unless instructed
- Keep area clean
- Apply antibiotic ointment if prescribed
- No baths until surgeon allows (usually 3-5 days)
- Pat dry gently
Managing Pain
Use paracetamol (e.g. Calpol) for pain and any fever, dosed by your baby’s weight at 15 mg/kg/dose. Always check the strength printed on your bottle before measuring, as drops and syrup are different concentrations. The table below is a guide based on common Indian formulations:
| Baby’s Weight | Calpol Drops (100 mg/ml) | Calpol Syrup (120 mg/5 ml) |
|---|---|---|
| 5-6 kg | 0.5-0.6 ml | 2.5 ml |
| 6-8 kg | 0.6-0.8 ml | 3-4 ml |
| 8-10 kg | 0.8-1 ml | 4-5 ml |
| 10-12 kg | - | 5-6 ml |
Give every 4-6 hours as needed, no more than every 4 hours, and do not exceed 60 mg/kg in 24 hours (usually a maximum of 4 doses). Do not give paracetamol to a baby under 3 months of age without a doctor’s advice. If your baby is under 3 months old, any fever needs to be seen the same day (see below) rather than only being medicated at home.
When to Worry After Surgery
Call Surgeon IMMEDIATELY if:
- Any fever of 100.4°F (38°C) or higher if your baby is under 3 months old — this needs same-day medical review, do not just medicate and wait at home
- Fever above 102°F (38.9°C), or any fever lasting more than 24 hours
- Blue or grey color at tip of penis
- Bleeding at surgical site
- No urination for 8+ hours
- Catheter falls out (if one was placed)
- Extreme pain despite medication
- Signs of infection (pus, increasing redness, swelling)
🚨 For a baby who is struggling to breathe, limp, unresponsive, having a seizure, or a tip of penis turning blue/grey: call 112 (national emergency) or 108 (ambulance), or go to the nearest hospital immediately.
Normal Post-Surgery Signs
- Mild swelling (1-2 weeks)
- Bruising (1-2 weeks)
- Some fussiness (few days)
- Blood-tinged urine initially
Recovery Timeline
| Time | What to Expect |
|---|---|
| Day 1-3 | Most discomfort, fussy baby |
| Day 3-7 | Improving, less pain medication needed |
| Week 1-2 | Catheter removal (if placed) |
| Week 2-4 | Swelling resolving |
| 2-3 months | Mostly healed |
| 6 months | Full healing complete |
Activity Restrictions After Surgery
| Activity | When to Resume |
|---|---|
| Normal diaper changes | Immediately (be gentle) |
| Bathing | 3-5 days (surgeon’s guidance) |
| Sitting toys (walkers, etc.) | 4-6 weeks |
| Swimming | 6-8 weeks |
| Normal play | 2-4 weeks |
Potential Complications
Most surgeries are successful, but possible complications include:
| Complication | What It Is | Solution |
|---|---|---|
| Fistula | Abnormal opening develops | May need minor repair surgery |
| Stricture | Scar tissue narrows urethra | May need dilation or surgery |
| Breakdown | Part of repair fails | May need revision surgery |
| Infection | Surgical site infection | Antibiotics |
Note: Complications are uncommon with experienced pediatric urologists.
Long-Term Outlook
With successful surgery, most boys can expect:
- Typical urination (standing up)
- Good sexual function in adulthood
- A near-typical appearance
- Fertility that is usually unaffected by the hypospadias itself
Regular follow-up with the urologist is important for the first few years.
FAQs
Q: My baby has mild hypospadias. Does he really need surgery?
A: Even mild hypospadias is usually repaired to ensure normal urine stream direction (important for standing urination), cosmetic appearance, and prevent potential issues with sexual function later. Discuss with a pediatric urologist.
Q: Baby has fever 101°F after hypospadias surgery. What should I do?
A: A low-grade fever (up to 101°F) in the first 24-48 hours after surgery is common. Give Calpol for comfort, dosed by weight. However, if your baby is under 3 months old, any fever of 100.4°F (38°C) or higher must be seen by a doctor the same day — do not just medicate and wait. For any baby, contact your surgeon immediately if the fever is above 102°F, lasts more than 24 hours, or your baby seems very unwell, unusually drowsy, or is feeding poorly.
Q: Should we get our baby circumcised if he has hypospadias?
A: NO! If hypospadias is present, circumcision should NOT be done. The foreskin tissue is often needed for surgical repair. Always inform the doctor about hypospadias before any procedure.
Q: How much does hypospadias surgery cost in India?
A: Costs vary widely based on hospital, surgeon, and severity. Generally ranges from Rs. 40,000 to Rs. 2,00,000 in private hospitals. Government hospitals offer subsidized or free treatment.
Q: Will my son remember the surgery?
A: One reason surgery is recommended between 6-18 months is that children at this age are very unlikely to form lasting conscious memories of the procedure, which helps reduce psychological impact. Your surgical and anaesthesia team will also focus on keeping your baby comfortable and well-managed throughout.
Q: Can hypospadias recur after surgery?
A: Once properly repaired, hypospadias doesn’t recur. However, complications like fistula may need additional surgery in some cases. Regular follow-up ensures any issues are caught early.
This article was reviewed by a pediatrician. Last updated: January 2025
General information for Indian parents, not a substitute for your pediatrician. In an emergency, call 112 or 108.
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