How to take care of yourself after hypospadias surgery?

Hypospadias is a common physical disease in men. It usually causes testicular insufficiency in the front of the penis and the perineum below the glans. Hypospadias surgery is a common treatment for hypospadias. Postoperative care is very important. After hypospadias surgery, the wound area must be kept clean and infection must be prevented.

1. Avoid getting the surgical area wet within 7 days after surgery;

2. Keep the surgical site clean to prevent infection. If there is blood scab or secretion on the wound, wipe it with sterile saline;

3. After the operation, you can apply pressure bandage or ice pack to the local wound, but the pressure should not be too high to avoid damaging the penis. If bleeding and severe hematoma occur after the operation, you should go to the hospital for follow-up immediately;

4. Rest in a quiet and comfortable environment after the operation. Do not watch TV or read newspapers within 2 weeks after the operation. It is best to rest in a semi-recumbent position (raise the pillow) when lying in bed to avoid excessive fatigue of the penis or too low a position of the head, which may aggravate the swelling of the wound.

5. The wound will be a little painful on the day of surgery, but it will gradually ease over time. Patients should not rush to take painkillers, because aspirin-like drugs will aggravate wound bleeding;

6. Avoid eating spicy foods such as chili peppers;

7. Strictly follow the doctor’s instructions on medication and follow-up visits.

1. Hormonal factors

The hormones produced in the fetal testes affect the formation of the male external genitalia, which is completed around the 14th week of embryonic development. This developmental process requires the stimulation of dihydrotestosterone. Dihydrotestosterone is converted from testosterone secreted by the fetal testes under the action of 5α-reductase. Therefore, during the formation of the fetal penis, any insufficient or delayed production of testosterone or abnormalities in the conversion of testosterone to dihydrotestosterone can lead to genital malformations.

(B) Genetic factors

Hypospadias has a clear familial tendency. It has been reported that the chromosomal aberration rate in patients with hypospadias is significantly higher than that in the normal population. Others believe that mutations in sex differentiation-related genes, such as the androgen receptor gene (AR) and the sex determination gene (SRY), are closely related to hypospadias.

(III) Environmental factors

Studies have found that the incidence of hypospadias is higher in babies who have used progesterone or other drugs in early pregnancy and those conceived in winter.

Preoperative preparation

1. For those with a small penis, male hormone therapy should be used appropriately, and surgery can be performed after the penis develops.

2. Patients with urinary tract infection must strictly control the infection before surgery.

3. Wash the perineum with soapy water every day for 3 days before the operation and apply chlorhexidine wet compress.

4. Carefully examine the position of the urethral opening, accurately estimate the position of the urethral opening after penis straightening, and measure whether the foreskin, penis and scrotal skin can be used. Through comprehensive judgment, decide whether to use a single-stage or staged surgery and what surgical method to use.

1. Position: Same as penis straightening surgery.

2. Incisions: Two parallel oblique incisions are made on the ventral side of the penis around the urethral opening, with a distance of about 1/3 of the penis circumference. The two incisions are made obliquely to the dorsal side of the penis and reach the coronal sulcus, slightly exceeding the dorsal midline. Then they are connected together to form the skin flap C of the skin tube.

3. Penis straightening and urethroplasty: First, make an additional incision along the coronal groove to form flap A. Lift flap A to expose the fiber band in the center of the ventral side of the penis, which is completely removed to fully straighten the penis. Then insert a catheter from the urethral opening, slightly separate the periphery of flap C and wrap it around the catheter to form a tube with the wound surface facing outward. Use 5-0 nylon or silk thread to suture intermittently, and tie the knot on the inside of the tube so that it will fall off by itself after the operation. Make a tunnel at the glans penis, bury the distal end of the prepared tube in the tunnel, and suture the outer opening of the tube to the wound edge of the glans penis. Although the urethra formed in this way is slightly curved, it does not affect the smooth flow of urine.

4. Closure of wound: Separate flaps A and B, and make an additional transverse incision in the coronal sulcus. Pull the flaps toward the center of the abdomen and make two rows of sutures (same as urethroplasty with buried leather strips). At the end of the operation, remove the catheter, place a rubber sheet drainage strip in the newly formed urethral opening, and fix the penis to the abdominal wall with a traction wire or thin wire.