In Grades I, II, IIIa, when the child has no complaints or problems, there is no need to perform any tests before surgery. However, some hospitals prefer to do routine blood check, blood coagulation tests, urine analysis, or ultrasound on the kidney and bladder.

In Grade IIIb and Grade IV, blood check, blood coagulation tests, urine analysis, or ultrasound on the kidney and bladder is recommended according to the doctor’s evaluation of each individual child.

In glanular and distal hypospadias (Grade I, II, IIIa) with both testes in the scrotum, this is not necessary.

In perineal hypospadias (Grade IIIb, Grade IV) or when hypospadias is associated with undescended testis and in patients suspected of having disorders of sexual development (DSD), chromosomal analysis is important to accurately identify the gender of the child.

Glanular and distal hypospadias and the majority of proximal hypospadias do not need pre-operative hormonal treatment. Some surgeons prefer to use pre-operative hormonal treatment in the form of cream or injections in severe forms of proximal hypospadias. The drawback with hormonal treatment is that it does not affect the penis only but affects the whole body including bone growth, and the effect of hormones on the penis is temporary (about 1 month after therapy).

Prof. Hadidi does not recommend using pre-operative hormonal therapy as a routine because of its adverse effects on the body in general and because it alters the tissues of the penis and increases the chances of bleeding. However, pre-operative hormonal therapy may be helpful in patients with Disorders of Sexual Development (DSD) or when the phallus is very small.

Vaccination makes the immune system weaker than normal for about a month. Therefore, it is recommended that the last vaccination should be at least one month before surgery and the next vaccination should be at least one month after surgery.

If the child has a running nose only without fever or chest infection, the operation is performed as planned in our centre. Diarrhea in our centre does not postpone the operation, but must always be discussed beforehand with the doctors. However, each hospital has a different protocol of management.

Children with glanular or distal hypospadias usually can go home between 1–5 days (average 3) after the operation, depending on the age of the patient, the family circumstances, and the degree of swelling after the surgery.

Children with proximal hypospadias (Grade IIIa) usually have one transurethral catheter for 7 days and can go home on day 8.

Children with proximal hypospadias associated with deep chordee (Grade IIIb) have one transurethral catheter for 7–13 days and sometimes (rarely) another catheter through the abdominal wall into the bladder for about 2 weeks. The child may stay in the hospital up to 2 weeks but may go home earlier if the mother can look after the child and ensure that the catheter does not come out.

Children with perineal hypospadias usually require two-stage urethroplasty. In the first operation, the surgeon corrects the chordee (penile curvature) and prepares the glans for the urethroplasty. The hospital stay is 3–5 days. In the second stage, urethroplasty is performed to the tip of the penis and the hospital stay is usually 8–14 days.

The aim after hypospadias surgery is to fix the penis and not the child.

This means that the child can move around as soon as he is fully awake from anesthesia. He can sleep on his abdomen and lead a normal life. However, care must be taken to protect the genital area and to avoid unplanned removal of the catheter.

In glanular and distal forms (Grade I, II), the dressing is usually removed 1–2 days after the operation. In proximal forms (Grade III, IV), the dressing is usually removed 7–10 days after the operation.

Different surgeons have different protocols:

Prof. Hadidi removes the catheter from the urethra within the first 2–3 days in Grade I and II hypospadias, and after 7–10 days in proximal hypospadias (Grade III, IV) or in complicated hypospadias cases.

Grade I and II receive antibiotics and local ointment for one week after surgery.

Grade III and IV receive antibiotics and local ointment for two weeks after surgery.

You can clean immediately after surgery with a wet towel. When you clean the penis, this should be done longitudinally along the wound and not across.

Your son can take a shower two weeks after surgery.

The idea is that we need to keep the wound clean and dry for proper healing and to avoid infection.

The wound takes one month to heal by 70%. That is why we try to avoid swimming, bathing, or sports for one month after surgery.

Ideally, you should wait for one month. However, if you can avoid trauma to the penis before, your son may go to the kindergarten earlier with special precautions.

Our standard protocol is to use 2 diapers immediately after surgery, and this should continue for a month after surgery. The idea is that diapers protect the penis from trauma.

However, for one week after surgery, we need to change the diapers every two hours when the child is awake. When he is asleep, you should not wake him up to change the diapers.

Our aim is to avoid trauma to the penis and the genital area for one month after surgery. Therefore, in addition to the two diapers your son is wearing, we recommend placing two folded diapers or a small soft cushion between the seat belt and the diapers over the penis.