Hypospadias Repair
Surgical repair of a congenital condition in which the urinary opening lies on the underside of the penis rather than at the tip. Function comes first — a straight stream and a straight penis — and appearance after that.
Last medically reviewed: October 6, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 1–3 hours depending on the type
- Anesthesia
- General anaesthesia, often with a caudal block
- Hospital stay
- Day case – 1 night
- Stay in Türkiye
- 10–14 days
- Catheter duration
- 5–10 days
- Return to work
- Back to nursery or school in 2–3 weeks
- Flight clearance
- After catheter removal and review
About the condition
Hypospadias is a congenital condition in which the urinary channel (the urethra) does not reach the tip of the penis but opens somewhere along its underside. It is common in boys, and it is not a disease or the result of anything done wrong. The question parents ask most often — "was this something we caused?" — has a clear answer: no.
Three findings are assessed together: where the opening lies, whether the penis curves downwards (chordee), and the deficiency of foreskin on the upper side. These are not present to the same degree in every child. When the opening is near the tip (distal) the picture is usually milder; when it lies at the base of the penis or in the scrotum (proximal) a more extensive repair is needed.
The decision to operate is not based on appearance alone. The real questions are: can the child pass urine forwards while standing, does the stream spray or point downwards, and is the penis visibly curved on voiding or later on erection. In some very mild cases — opening close to the tip, no curvature — surgery may not be needed, and that is a legitimate conclusion which is stated plainly to families.
AN IMPORTANT WARNING: a boy with hypospadias MUST NOT BE CIRCUMCISED BEFORE THE REPAIR. The foreskin is the most valuable tissue available for reconstruction; once it has been removed the surgeon has lost the best material and the repair becomes harder. If the position of your child’s urinary opening looks unusual, a urologist should see him before any circumcision.
The preferred window for surgery is usually within the first year, and guidelines most often point to 6–18 months. That period is chosen because the child will not remember the event and healing is rapid. If the child presents later, repair is still possible; there is no such thing as "too late" — only a different plan.
In some boys hypospadias does not occur alone: an undescended testis or an inguinal hernia may accompany it. Where the opening is very proximal and the testes cannot be felt, an assessment of sex development may be requested. That request is not meant to alarm; it is there so that the right diagnosis is not missed.
The aims of repair, in order, are: urine leaving forwards as a single stream; a straight penis; an opening near the tip and of adequate calibre; and an appearance similar to that of other boys. Appearance comes last on that list, because appearance means little until function is right.
Who is it suitable for?
May be suitable
- Boys whose stream sprays, points downwards, or makes standing to urinate difficult
- Boys with visible curvature of the penile shaft (chordee)
- Boys whose opening lies mid-shaft, at the base, or near the scrotum
- Boys already repaired elsewhere who have developed a fistula or a stricture
- Adults never repaired in childhood who have difficulty voiding or with sexual function
May not be suitable
- Boys whose opening is very close to the tip, with no curvature and no functional complaint — surgery may not be advised
- Boys with an active urinary infection: the infection is treated first
- Selected boys with a small penis who may need hormonal preparation before surgery, so planning is deferred
- Boys with additional anaesthetic risk who need paediatric assessment first
Technology used
- Magnified surgery using an operating microscope or loupes
- Fine paediatric instruments and fine absorbable suture material
- A vascularised tissue cover prepared from the foreskin
- Buccal mucosa graft where required
- Paediatric anaesthetic team and caudal block for postoperative pain
- Soft, fine-calibre urethral catheter or dripping stent
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
Birth details, notes of any previous surgery, a short video or photograph of the child voiding, and a urinalysis are reviewed. We always ask whether circumcision has already been performed, because that changes the plan directly.
- Day 1
Examination and anaesthetic assessment
Examination establishes the position of the opening, the degree of curvature and the quality of the tissue. Blood tests and a urine culture are taken. If the culture grows an organism, surgery is postponed.
- Day 2
Surgery
Under general anaesthesia the curvature is corrected, a new urinary channel is formed and covered with a vascularised layer of tissue. That covering layer is placed specifically to reduce the chance of a later fistula. A fine catheter is left at the end of the procedure.
- Days 2–3
Discharge
Most children go home the same or the following day. How to protect the dressing, how the catheter drains, and when to seek help immediately are all explained in writing.
- Days 5–10
Catheter removal
The catheter is removed here. The first void afterwards is observed to confirm a single forward stream. For that reason the return flight is not planned for the day after removal.
- Weeks 3–6
Review
Healing and the urinary stream are assessed. Photographs and a video of the stream may be requested for remote follow-up.
Method comparison
| Criterion | Distal (near the tip) | Proximal (at the base) |
|---|---|---|
| Operating time | Shorter | Longer |
| Number of stages | Usually single stage | Two stages are often planned |
| Correction of curvature | A limited manoeuvre usually suffices | More extensive correction needed |
| Need for additional tissue | Usually none | Graft or extra cover may be needed |
| Likelihood of fistula | Lower | Higher |
| Duration of catheter | Shorter | Longer |
| Stay in Türkiye | Shorter | Planned longer |
This table is not a ranking; it is an adjustment of expectations. A higher chance of a second operation in a proximal case is not a failure but the nature of the problem. If you are travelling from abroad, build that possibility into your plans from the outset.
Risks
- FISTULA (URINE LEAK): the most common complication. A small opening forms between the new channel and the skin and some urine passes through it. Small fistulas sometimes close on their own; if not, repair is usually carried out after a few months through a second small operation. This does not mean the first operation failed
- STRICTURE: narrowing can develop at the new opening or along the channel. It shows as a thinner stream, straining or dribbling and may require a further procedure
- Breakdown of part of the new channel (dehiscence) — particularly in proximal and complex cases
- Wound infection, with temporary swelling and bruising
- Incomplete correction of curvature, or recurrence as the penis grows; reassessment at puberty may be needed
- Ballooning of the channel (diverticulum) with post-void dribbling
- A cosmetic result that does not satisfy the family, or later the child
- THE POSSIBILITY OF FURTHER SURGERY: particularly in proximal cases a second procedure may be needed, and this is discussed in advance. No surgeon can guarantee a definitive result from a single operation
Alternatives
- Observation without surgery — a legitimate option where the opening is close to the tip, there is no curvature and the stream is normal
- Single-stage repair — the common approach in distal and mid-shaft cases
- Two-stage repair — in advanced proximal cases or where tissue is insufficient: curvature is corrected and tissue prepared first, the channel formed at the second stage
- Graft repair — buccal mucosa is used where the foreskin has already been removed
- Hormonal preparation before surgery — in selected boys with a small penis, to improve tissue
- Redo repair in boys operated elsewhere with an unsatisfactory result
Recovery
First 48 hours
Swelling and bruising are expected. Pain is usually controlled with simple analgesics. Plenty of fluids are given. Fever, a dressing that becomes soaked, or no urine draining from the catheter all require immediate contact.
Week 1
The child rests at home. In babies still in nappies, the nappy must not press on the dressing. Bicycles, ride-on toys and carrying the child astride the hip are avoided.
After catheter removal
The first few voids may sting. The stream should be a single jet directed forwards. Spraying or dribbling should be reported.
Weeks 2–4
Return to nursery or school usually falls in this period. Active play and sport wait a little longer. Scars look red at this stage and fade over months.
Months 3–6
The appearance settles. No firm judgement about the cosmetic result is made before this.
Puberty
As the penis grows, curvature and calibre are reassessed. A review at puberty for a boy repaired in childhood is routine, not a bad sign.
Frequently asked questions
My son has hypospadias — can he be circumcised?
Not before the repair. The foreskin is the most suitable tissue for reconstruction; once removed, that option is lost and a graft from inside the mouth may become necessary. Circumcision is usually arranged during or after the repair.
At what age should surgery be done?
Guidelines most often point to 6–18 months, because the child will not remember it and healing is rapid. Repair is also possible in older boys and in adults; there is no "too late", only a different plan.
Will one operation be enough?
In most distal cases a single stage is sufficient. In proximal cases two stages are commonly planned. No surgeon can guarantee a definitive result in one operation; choose a centre that discusses the possibility of a second one with you beforehand.
What happens if a fistula develops?
Small fistulas sometimes close spontaneously. If not, a few months are usually allowed for the tissue to soften and a small operation closes it. Operating immediately, on inflamed and swollen tissue, tends to make the result worse.
Will he be able to urinate standing up afterwards?
That is the first aim of the repair: urine leaving forwards as a single stream. Whether it has been achieved is assessed by observing him after the catheter is removed.
Will his sexual function be affected later?
One aim of the repair is a straight penis, which bears directly on later sexual function. As the penis grows at puberty, curvature may need reassessing. Knowing this now is better than being surprised by it later.
Is the catheter uncomfortable?
Children tolerate it better than parents expect. The catheter is usually left to drain freely into the nappy; a bag is not needed in most cases. Medication is given for pain and bladder spasm.
He was operated on elsewhere — can it be done again?
Yes. Redo repairs are harder because the tissue is scarred and the foreskin has usually been used; buccal mucosa grafting then comes into play. Please bring the previous operation notes and any photographs.
How long should we stay in Türkiye?
Because catheter removal and the first review are done here, 10–14 days is usually planned. Proximal cases may take longer. Do not plan the return flight for the day after catheter removal.
Will there be a scar?
Every surgical incision leaves a scar. The aim is for it to follow the natural lines of the penile skin and to fade. Redness in the first months is normal; firm assessment waits 3–6 months.
Is anaesthesia harmful to my child?
Paediatric anaesthesia uses child-specific doses and monitoring, which is why the pre-operative anaesthetic assessment is a separate step. Tell us in full about past illnesses, allergies and current medication.
What documents should we send?
Any previous operation notes and discharge summaries, a current urinalysis, a short video of your child voiding, and a photograph of the area. With these, the type and the likely number of stages can be assessed before you travel.
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This page is for general information only and is not a substitute for medical advice.
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