Hypospadial repair

1. HYPOSPADIAS REPAIR
Presented by----
Mrs. Usha Rani Kandula,
MSc.Nursing, Assistant professor,
Department of Adult Health Nursing,
College of Health Sciences,
Arsi University, Asella, Ethiopia.

2. DEFINITION
-Reconstruction of the distal urethra and
meatus from the ventral surface of the penis
to the normal position.

3. URETHRAL OPENING IN HYPOSPADIAS
CASE
-It is a congenital anomaly.
-In hypospadias, the urethral meatus may open
on the
-Distal end,
-Midshaft,
-at the penoscrotal junction, or
-on the perineum.

4. SURGICAL REPAIR
Depending on the degree of hypospadias,
-Meato-plasty,
-Glanulo-plasty,
-Urethro-plasty,
(straightening of the urethra), and/or
-Scroto-plasty may be indicated.

5. STAGES OF SURGICAL REPAIR
-The surgeon determines if the procedure can
be performed in a
-single staged repair or
-two-staged repair is necessary;
-Tissue graft or a rotational skin flap may be
required.

6. NO CIRCUMCISION IN CHILDREN
-Hypospadias repair is most often performed
on infants and children.
-Circumcision should not be performed on
infants and children with hypospadias.
-in order to preserve skin useful in correcting
the deformity.

7. ANOMALY IN THE FEMALES
-This anomaly infrequently occurs in the
female,
-with the urethra opening into the vagina.

8. PROCEDURE
-To correct the chordee,
-repair is accomplished by cutting the fibrous
tissue bands on the ventral aspect of the
penis.
-The absent portion of the urethra may be
reconstructed out of the foreskin.

9. RECOVERY OF GRAFT
-In circumcised patients, a tissue graft,
-e.g., a segment of vein or skin from a non hair-
bearing area,
-such as the inner aspect of the arm, may be
used.

10. SURGICAL INCISION
-An incision is made on the ventral aspect of
the penis.
-The reconstructed urethra,
-splinted from within by a catheter (e.g., Foley),
-is placed in the tunnel that is constructed,
-over which the remaining foreskin is grafted.

11. SURGICAL REPAIR ACCORDINGLY
DEFECT
-According to the severity of the defect,
The meatus,
Glans penis,
urethra, and/or scrotum may require repair;

12. PREPARATION OF THE PATIENT
-Following the administration of general
anesthesia,
-The patient is supine with the legs apart.
(well-separated).

13. PREVENTION OF LOWER BACK
STRAIN
-A pillow may be placed under the knees
(of the adult patient)
-to help maintain the position and to prevent
lower back strain.

14. ASSISTING PADDED ARM BOARDS
-For the adult (or large child),
-the arms may be extended on padded arm
boards and
-the safety strap is replaced above the knees
following positioning.

15. PREVENT NEUROVASCULAR
PRESSURE
-Pad all bony prominences and
-areas vulnerable to skin and neurovascular
pressure or trauma.

16. CHILDREN POSITIONING
-For infants and small children,
-the lower segment of the table and pad are
removed;
-this will permit closer access to the child in
supine position.

17. CARE OF CHILDREN DURING
POSITIONING
-Particular care must be taken to adequately
secure the child,
-while preventing trauma to areas vulnerable to
skin and neurovascular trauma or pressure.
-Apply pediatric-sized electrosurgical pad.

18. SKIN PREPARATION
-Cleanse entire pubic area
(penis, scrotum, and perineum),
-Extending from the umbilicus to the mid-
thighs.

19. DRAPING
-Cuffed towel under the scrotum,
-Folded towels around pubic area,
-A sheet with a small fenestration.
EQUIPMENT
-Electrosurgical unit (ESU)

20. INSTRUMENTATION
ADULTS
-Vasectomy tray
-Urethral sounds
INFANTS AND CHILDREN
-Pediatric plastic procedures tray
-Lacrimal duct probes

21. SUPPLIES
-Small plastic adhesive drapes
-Blades, (2) #15
-Small basin
-Water-soluble lubricant

22. -Needle magnet or counter Catheter, e.g., Foley
-Sterile marking pen
-Electrosurgical pencil with needle tip and cord
with holder and scraper.

23. -Dressing pad
(e.g., Adaptic, DuodermR™, Owen’s gauze),
-Gauze “fluffs,” and dressing sponge(s).
-Dressing is applied with light pressure,
when applicable to graft site
-T-binder or scrotal support
(adult or large child)

24. SPECIAL CONSIDERATIONS
-Give assurances and information as
necessary.
-Follow safety measures.
- Perioperative Record for patient safety and
medicolegal reasons

25. ASSISTS THE ANESTHESIA PROVIDER
-Assists the anesthesia provider during the
induction of anesthesia.
-Induction of anesthesia for children is usually
by mask,
-followed by intravenous (IV) sedation.

26. MEASURES TO TAKE REGARDING
ANESTHESIA
-For measures to take regarding anesthesia
administered to infants and children.
-Assorted pediatric-sized
-intravenous catheters,
-endo tracheal tubes,
-breathing circuit and bag,

27. -As well as
-suction catheters,
-humidifier,
-temperature probe (axillary or rectal), and
-appropriately sized electrodes for
electrocardiogram (EKG) are necessary.

28. DOCUMENTATION OF NURSING CARE
-Documentation contains the record of nursing
care
-that explains what has been done for the
(child) patient.

29. MAINTAIN PATIENT’S BODY
TEMPERATURE
-Take appropriate measures to maintain
patient’s body temperature,
-e.g., providing a warmed blanket.

30. PAEDIATRIC SAFETY MEASURES
-Neonates and infants are transported in iso-
lettes,
-warming lamps placed overhead are used to
maintain the pediatric patient’s temperature
while on the operating table,
-and the room temperature is adjusted
according.

31. PROVIDE EMOTIONAL SUPPORT
-It is important to provide emotional support to
the adult patient regarding feelings of altered
body image.
-Give the patient an opportunity to express his
feelings.

32. MAINTAIN PATIENT PRIVACY
-Respect the patient’s right to his/her feelings.
-Consider parent’s position and concerns
regarding their infant.

33. PATIENT SENSITIVITIES AND
ALLERGIES
-Check the chart for patient sensitivities and
allergies,
-including to iodine and latex products
(e.g., gloves, drains, or elasticized pressure
dressings).

34. OBTAIN INFORMATION FROM PARENTS
-For infants and children,
-obtain this information from parent(s).
THANKING YOU.