Hypospadias repair
Hypospadias repair is surgery for boys born with the urine opening on the underside of the penis instead of at the tip. The surgeon straightens the penis if needed, builds a new urine channel to the tip, and reshapes the skin, usually when a baby is 6 to 18 months old.
Also called hypospadias surgery, hypospadias operation, TIP repair, Snodgrass repair, tubularized incised plate repair, MAGPI, chordee repair, two-stage hypospadias repair
- Where
- Children's hospital or outpatient surgery center operating room
- Anesthesia
- General anesthesia with a numbing block (caudal or penile block)
- Time in the room
- About 1 to 3 hours
- Hospital stay
- Usually same day; sometimes one night
- Going home with
- Often a small dripping tube (stent) for about 5 to 10 days
- Back to normal
- About 1 to 2 weeks
- Back to work
- Daycare in about 1 to 2 weeks; parents often take a few days off
Overview
Hypospadias is one of the most common differences boys are born with, affecting about 1 in every 200 to 300 boys. The opening where urine comes out (the meatus) sits somewhere along the underside of the penis instead of at the tip. In most boys it is close to the tip. In some it is farther down the shaft, at the scrotum, or behind it. Often the foreskin is incomplete on the underside, like a hood, and some boys have a downward bend of the penis, called chordee.
In nearly all cases, nothing a parent did caused this. Early in pregnancy, the urine tube forms by closing along the underside of the penis, and in hypospadias it stopped short of the tip.
Surgery moves the opening to the tip, straightens the penis if needed, and gives it a typical appearance. The goals are a straight penis for erections later in life, a forward stream so your son can stand to pee, and a natural look. Most boys need one operation. Boys whose opening is far back may need a planned two-stage repair, with the stages usually about 6 months apart.
Many surgeons recommend repair between 6 and 18 months of age, often around 6 to 12 months. At this age healing is good, children do not remember the surgery, and it is finished well before toilet training. The American Academy of Pediatrics supports this timing.
The parts of your body involved
The urethra is the tube that carries urine from the bladder through the penis. It normally opens at the tip of the glans, the head of the penis. In hypospadias, the urethra stops short, and the tissue that should have wrapped around it lies open and flat along the underside as a moist strip called the urethral plate. Surgeons use this plate to build the missing part of the tube.
- Glans
The head of the penis. In hypospadias it is often split open slightly on the underside.
- Meatus
The opening where urine comes out. In hypospadias it sits on the underside, anywhere from just below the tip to near the scrotum.
- Urethra
The urine tube. The repair extends it to the tip.
- Urethral plate
The flat strip of tissue between the opening and the tip. It is rolled into a tube to make the new urethra.
- Foreskin
Often incomplete, gathered on top like a hood. It can be rebuilt, removed, or used as tissue for the repair.
- Shaft
The body of the penis. A downward bend here is corrected during surgery.
Why it’s done
Repair is recommended for most boys with hypospadias. Very mild forms, with the opening just below the tip and no bend, do not always need surgery, and your surgeon will discuss this with you.
- A straight stream for standing to pee
When the opening is lower, the stream may spray or aim down, making it hard to pee standing up.
- Straight erections
A downward bend can make sex difficult in adulthood. Straightening it as a baby avoids this.
- A typical appearance
Many families, and later many boys, care about how the penis looks.
- A narrow opening
Some boys with hypospadias also have a small opening that needs widening.
- Better before memory and toilet training
Surgery in infancy is finished before your son is aware of his body and before he learns to use the toilet.
Other options
- No surgery, for very mild cases
When the opening is just below the tip, the stream is straight, and there is no bend, some families choose no surgery. This is a reasonable choice to discuss.
- Surgery at an older age
Repair can be done at any age. Many surgeons prefer infancy, and some studies suggest more healing problems when repairs are done later.
- A planned two-stage repair
For more severe forms, the first operation straightens the penis and places tissue, and the second, months later, completes the tube.
- Hormone treatment before surgery
For a small penis, some surgeons give testosterone cream or injections for a few weeks before surgery to make the repair easier. This is given in addition to surgery.
Getting ready
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Months before
The week before
The day before and the morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
Your son falls asleep breathing anesthesia gas through a soft mask, often with a parent nearby. An IV is placed once he is asleep, and he receives an antibiotic.
After the operation
Right afterward
- Waking up
Your son may wake up crying, confused or hungry. The numbing block keeps the penis comfortable for several hours.
- Feeding
He can usually start with small drinks soon after waking, and most children eat normally the same day.
- Double diapering
A nurse shows you how it works: the stent passes through a small slit in the inner diaper and drains into the outer diaper. This keeps stool away from the repair.
- Medicines
You go home with acetaminophen (and ibuprofen if allowed), often a medicine for bladder spasms, and sometimes an antibiotic while the stent is in.
- Going home
Most boys go home the same day. Boys with more complex repairs may stay one night.
At home
- Pain
Give acetaminophen, and ibuprofen if allowed, on a schedule for the first 2 to 3 days. Many children need little after that.
- Bladder spasms
With a stent, the bladder can cramp. You may see sudden crying, drawing up of the legs, and urine leaking around the stent. Spasm medicine helps, but can cause flushed cheeks, a dry mouth or constipation.
- Stent care
Do not pull on the stent. Urine should drip into the outer diaper. Some urine also leaks around it, which is fine as long as he is making wet diapers regularly.
- The dressing
Leave the dressing alone until the day your team says to remove it, often 2 to 5 days, or until it falls off. Some surgeons ask you to soak it off in a warm bath.
- Bathing
Sponge baths at first. Many surgeons allow short soaks in warm water after a couple of days, which soothes the area and helps the dressing come off. Follow your own team's advice.
- Ointment
Once the dressing is off, put petroleum jelly or antibiotic ointment on the tip and on the diaper at every change, so the penis does not stick.
- How it looks
Swelling, bruising and a purplish color are normal for 1 to 2 weeks. The final shape settles over a few months.
- Activity
Avoid straddle toys, baby walkers, jumpers, ride-on toys and swings with a seat between the legs for about 2 to 3 weeks. Car seats are fine.
- Bowels
Avoid constipation with plenty of fluids and fruit, since straining is uncomfortable and spasm medicine can slow the bowels.
- Stent removal
The stent usually comes out in the clinic after about 5 to 10 days. It takes seconds: the holding stitch is cut and the stent slides out.
Recovery timeline
- Day 0Surgery
Most boys go home the same day with a stent and dressing.
- Days 1 to 3The sore days
Pain and bladder spasms are at their worst. Give medicines on schedule.
- Days 2 to 5Dressing off
The dressing is removed or falls off. Ointment at every change.
- Days 5 to 10Stent out
A quick clinic visit to remove the stent.
- Weeks 2 to 3Back to normal
Swelling settles. Your son can return to daycare and normal play, including straddle toys once your team agrees.
- 2 to 3 monthsCheck-up
The surgeon checks healing, the shape of the penis and the opening.
- After toilet trainingWatching the stream
A straight single stream from the tip is the goal. A second stream, dribbling from the shaft or straining are reasons to call.
- Puberty and beyondLong-term check
Many surgeons like to see boys again around puberty, when the penis grows and late problems can show up. Most boys have normal function.
What it feels like
For parents, the hardest parts are handing your baby to the anesthesia team and the first few days of stent and diaper care. Babies usually recover faster than their parents expect, and they do not remember the surgery.
The morning of surgery
Parents often feel anxious, and some feel guilty about putting a baby through surgery.
What helpsBring comfort items, ask to be there as he falls asleep if allowed, and know that the team does this every day. Babies pick up on a calm voice and touch.
Seeing him after surgery
The dressing and tube can look alarming. He may cry more from hunger, confusion or the strange setting than from pain.
What helpsFeed and hold him. If he seems to be in pain, ask the nurse to check that the block is still working.
The first night home
Sleep is broken by diaper checks, spasms and worry.
What helpsGive pain and spasm medicine on schedule, keep notes of doses, and take turns with another adult if you can.
Double diapers
Fiddly and nerve-racking the first few times.
What helpsPractice with the nurse before you leave and ask for a printed sheet. By day two, most parents are experts.
When the dressing comes off
The penis looks swollen, bruised and maybe an odd shape. Many parents are shocked.
What helpsThis is expected. The swelling settles over weeks, and the final look takes a few months.
Stent removal day
Parents dread it, and then it takes only seconds.
What helpsBring a bottle or snack to comfort him right afterward.
Months later
Relief at a straight, normal-looking penis, and some watchfulness at toilet training.
What helpsWatch the stream once he is toilet trained. If you see a second stream or dribbling from the shaft, let the surgeon know.
How well it works
A successful repair gives a straight penis, a single forward stream from the tip, and a natural appearance.
- Repairs near the tip
For hypospadias near the tip, about 9 in 10 boys or more need no further surgery.
- More severe forms
When the opening is far back on the shaft or at the scrotum, complications are more common, and some boys need more than one further operation.
- How it is checked
Visits after surgery, a look at the stream once he is toilet trained, and in older boys sometimes a urine flow test.
- Long term
Most boys who have hypospadias repaired as babies grow up with normal urination and erections. Follow-up through puberty helps catch late problems early.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Expected for 1 to 2 weeks.
Common while the stent is in. Medicine helps.
Common while the tip is swollen; it usually settles.
Less common
A small extra hole on the underside of the penis where urine leaks out. It is usually closed with a smaller operation at least 6 months later.
Can cause a thin, forceful stream or straining. Treated with stretching or a small procedure.
The closed sides of the glans come apart, leaving the opening lower than intended. Some boys need a redo.
Spreading redness or pus, treated with antibiotics.
Some bend can persist or appear later as the penis grows, and may need correction.
Rare
A ballooning of the new urethra that holds urine and causes dribbling. May need repair.
Rare.
Serious problems in healthy babies are very rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher
- No wet diaper for 6 to 8 hours, or straining and crying with no urine coming out
- The stent falls out in the first few days. Call the same day, and do not try to put it back
- Bleeding that soaks the dressing or does not stop after 10 minutes of gentle pressure
- The tip of the penis turns dark blue or black, or the dressing looks too tight
- Spreading redness, foul-smelling drainage or pus
- Crying that cannot be soothed with medicine and comfort
- Vomiting, refusing to drink, or very few wet diapers
Questions to ask your surgeon
- Where is my son's opening, and how mild or severe is his hypospadias?
- Does he have a bend, and how will you fix it?
- Will the repair be done in one stage or two?
- Which technique do you plan, and how many of these repairs do you do each year?
- Will he have a stent and dressing, and for how long?
- Will you rebuild the foreskin or remove it?
- Do you recommend hormone treatment before surgery?
- How should we manage pain and bladder spasms at home?
- What signs of a fistula or narrowing should we watch for later?
- Does he need any other tests, for example for an undescended testicle?
- How long will you follow him, and should he be seen again at puberty?
Words you may hear
- Hypospadias
- A condition in which the urine opening is on the underside of the penis instead of at the tip.
- Meatus
- The opening where urine comes out.
- Glans
- The head of the penis.
- Urethral plate
- The flat strip of tissue on the underside that is rolled into the new urethra.
- Chordee
- A downward bend of the penis, most noticeable with erections.
- TIP repair
- Tubularized incised plate repair, the most common hypospadias operation.
- Two-stage repair
- A repair done in two planned operations, used for more severe forms.
- Stent
- A thin, soft tube left in the new urethra for a few days so urine drains while it heals.
- Caudal block
- A numbing injection low in the back that blocks pain below the waist for several hours.
- Double diapering
- Two diapers worn together so the stent drains into the outer one, away from stool.
- Fistula
- A small extra opening on the underside of the penis where urine leaks out.
- Meatal stenosis
- Narrowing of the urine opening.
- Dehiscence
- When stitched tissue comes apart during healing.
Common questions
Did I cause this?
Almost certainly not. Hypospadias happens early in pregnancy, often before anyone knows they are pregnant, and in nearly all cases there is nothing a parent did or could have done to prevent it.
Is anesthesia safe for a baby?
For healthy babies, anesthesia given by a pediatric team is very safe. In 2016 the FDA added a warning about long (more than 3 hours) or repeated anesthesia in children under 3. Most hypospadias repairs are a single, shorter operation, and pediatric experts support doing needed surgery at this age. Ask your anesthesiologist about your son's situation.
Will he remember the surgery?
No. Babies operated on at 6 to 18 months do not remember it, which is one reason this age is preferred.
Will he be able to stand to pee and have normal sex and children?
After a successful repair, most boys stand to pee with a straight stream and grow up with normal erections and sexual function. Fertility is usually normal, especially in milder forms.
What if he needs another operation?
Most problems, such as a small fistula, are fixed with a shorter operation, usually at least 6 months after the first so the tissue can heal fully.
Can he be circumcised at the same time?
Often yes. Many surgeons remove the foreskin as part of the repair, and others rebuild it if you prefer. Tell your surgeon what you want before the operation.
Sources this page draws on
- American Academy of Pediatrics, Section on Urology, Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia (1996)
- European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU), Guidelines on Paediatric Urology
- Centers for Disease Control and Prevention (CDC), Facts about Hypospadias
- Urology Care Foundation, Hypospadias
- MedlinePlus, U.S. National Library of Medicine, Hypospadias repair
- U.S. Food and Drug Administration (FDA), Drug Safety Communication: new warnings about general anesthetic and sedation drugs in young children and pregnant women (2016)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.