Parents preparing for their son's hypospadias surgery tend to ask much the same questions in clinic. Is general anaesthesia safe for a baby? How many days will the catheter stay in? How do we look after the dressing and nappies at home? And what happens if urine leaks from somewhere else after the operation? These worries usually grow as the date gets closer.
This guide goes through what parents are most anxious and curious about before surgery — general anaesthesia, the catheter and dressings, care at home, fistulas and redo surgery — in the order I would explain them in clinic. The operation and its timings depend on the child and the technique, so what follows is general guidance; your own surgical team's plan comes first.
When is hypospadias surgery done, and is general anaesthesia safe for a baby?
The first hypospadias repair is usually done between 6 and 18 months of age, the window given in the European paediatric urology guideline. Surgery is not done in the newborn period because the tissues are easier to work with once the penis has grown a little, and anaesthesia is more settled. Leave it much later, and a child may remember the operation and hospital stay, and become frightened.
What parents fear most is whether general anaesthesia might affect a baby's brain development. An international randomised trial (the GAS trial) was run to answer exactly this. Young infants were randomised to general or regional anaesthesia and had IQ testing at age 5: children who had about an hour of general anaesthesia did no differently from those who did not. It does not cover every situation, but it is good evidence that anaesthesia for one planned operation need not be feared. The method and duration are set by a paediatric anaesthetist for each child.
The day of surgery and the hospital stay
The operation is done under general anaesthesia, usually combined with a caudal block (an injection near the tailbone) or a penile nerve block to reduce pain during and after surgery; the guideline regards both as giving adequate pain relief. It is common for a child to cry and be unsettled for a while on waking in unfamiliar surroundings.
Children used to stay in hospital until the catheter was removed; now it is usual to go home with the catheter in place. After a simpler repair most go home around day 3, and after a repair that builds a new urethra from skin, around days 3–5. So parents look after the catheter and dressing at home for some days.
The catheter and dressings — what parents ask most
The catheter (stent) is a thin tube that lets urine bypass the repair while the new urethra heals. How long it stays depends on the operation. The figures below are one example; they vary between hospitals and surgeons.
| Type of operation | Catheter time (example) |
|---|---|
| Simple distal repair (opening near the tip of the penis) | 5–7 days |
| Proximal repair (opening near the base of the penis or the scrotum) | About 7 days |
| Single-stage repair building a new urethra from skin | About 14 days |
There is no evidence that the type of catheter or dressing changes the result of the operation, and no agreement on the best number of days. That is why hospitals differ, and why the durations you hear from other families differ too.
The dressing usually has several layers: for example, a foam dressing that cushions the wound and absorbs ooze, a light compression layer of elastic bandage (Coban) to limit swelling and bleeding, and a waterproof film (Tegaderm) to keep urine and stool out.
At home, the main job is protecting the dressing and catheter inside the nappy. Many parents cut a hole in the middle of an inner nappy so the catheter drains into an outer nappy, and place a barrier below to keep stool off the dressing. It feels awkward at first, but most families get used to it within a day or two.
Once surgery is booked, a specialist nurse in clinic goes through what to prepare and how to manage the dressing and nappies, with a printed leaflet. Things that vary between hospitals — bathing, activity, when the dressing comes off — can be checked then. It is safer to follow that guidance than methods found online.
What to watch at home, and when to call
In the first days after surgery, the following are common and usually nothing to worry about:
- Swelling and bruising of the penis and around it. Swelling usually settles slowly over 2–3 weeks.
- A little blood-stained ooze around the catheter or on the dressing.
- Sudden fussing with a little urine leaking beside the catheter. This may be bladder spasm, the bladder reacting to the catheter; medicine can be prescribed if needed.
Do not wait — contact the hospital if:
- your child has a temperature of 38°C or more;
- the catheter comes out earlier than planned;
- no urine has come through the catheter for several hours and your child is in pain in the lower tummy and very unsettled;
- the dressing keeps soaking through with blood;
- the glans or skin turns dark, or there is smelly, pus-like discharge.
Problems after surgery — fistula, stricture and redo surgery
Hypospadias repair is a common operation, but problems can arise as the new urethra heals. Knowing about them plainly tends to reduce worry rather than add to it.
| Problem | What it is | How you notice it |
|---|---|---|
| Fistula | A small hole along the new urethra through which urine leaks | After the catheter comes out, urine comes out in two streams or leaks from the underside of the penis |
| Meatal or urethral stricture | Narrowing of the opening or of the urethra | A thin stream, straining or taking a long time, or dribbling |
| Glans dehiscence | The stitched-together glans comes apart | The opening looks lower again. Function is often not much affected |
| Recurrent curvature | The straightened penis bends again | Often not obvious in early childhood; may show at puberty, when erections become frequent |
How often these occur depends heavily on how severe the hypospadias is. In the data summarised by the European guideline, even for simple distal hypospadias the success rate of the first repair is 85–90%, so one or two children in ten may have a problem that needs further attention. Proximal hypospadias is a difficult operation, with complication rates reported from 14% to 68%. Overall ranges are 5–50% for fistula, 5–15% for meatal stenosis, 8–13% for urethral stricture and 9–17% for glans dehiscence; the lower ends mostly come from distal repairs and the upper ends from proximal and redo surgery.
What to know about fistulas and redo surgery
A fistula usually does not close on its own, but it can be repaired. Rather than operating again straight away, the repair is usually done after waiting about six months for the tissues to recover fully, so there is no need to rush back to surgery when a fistula appears. Meatal narrowing is likewise treated with a simple procedure or an operation, depending on how severe it is.
"Redo surgery" can sound frightening. Long-term studies have found that a substantial share of boys have further surgery by age 15, most often after proximal hypospadias. That says less that the first operation failed than that hypospadias needs checking again as a child grows. This is why the urine stream and the shape of the penis are followed until puberty. What is checked is set out in What Is Hypospadias Surgery Actually Correcting?
Frequently asked questions
Does it hurt when the dressing comes off?
A child may be startled and uncomfortable when the dressing is removed. It is usually brief, and the team will do it in a way that limits discomfort.
Does the catheter hurt while it is in?
The catheter does not hurt all the time, but if the bladder suddenly contracts in response to it, a child may fuss and urine may leak beside the catheter. If this happens often, tell the team; it can be eased with medicine.
When does the penis settle into its final appearance?
Swelling usually takes 2–3 weeks to go down, and scars and shape take 3–6 months to settle. There is no need to judge the result by how it looks straight after surgery.
How do one-stage and two-stage repairs differ?
In proximal hypospadias, with marked curvature or a long section of urethra to build, data suggest that doing the repair in two stages has fewer complications. More detail is in the FAQ of What Is Hypospadias Surgery Actually Correcting?
Standard and debated technique, and how a good result is defined, are covered with the evidence here.
Hypospadias technique — what is standard and what is still debated
Hypospadias, Part 2 — What counts as a good result?
Written for clinicians.
References
- EAU Guidelines on Paediatric Urology. Chapter 9, Hypospadias (§9.5 Management; §9.6 Outcomes and complications; §9.7 Long-term follow-up). European Association of Urology, 2026 edition. uroweb.org
- McCann ME, de Graaff JC, Dorris L, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, multicentre, randomised, controlled equivalence trial. Lancet. 2019;393(10172):664-677. doi:10.1016/S0140-6736(18)32485-1