section name header

Information

  1. HYPOSPADIAS
    1. Introduction: Hypospadias is a congenital anatomical defect of the male genitourinary tract, readily detected at birth through simple visual examination. In hypospadias, the urethral opening is located on the ventral surface of the penile shaft; this makes voiding in the standing position virtually impossible, which creates potential for serious psychological problems. Ideally, staged surgical repair should be completed by 6 to 18 months of age, before body image is developed or castration fears are evident.
    2. Assessment:
      1. Urethral opening is located on ventral surface of penis.
      2. May be accompanied by "chordee"—ventral curvature of the penis due to a fibrous band of tissue.
      3. Rare: ambiguous genitalia, resulting in need for chromosomal studies to determine sex of neonate.
    3. Analysis/nursing diagnosis:
      1. Altered urinary elimination related to congenital anatomical defect of penis.
      2. Pain related to surgery and treatments.
      3. Self-esteem disturbance related to anatomical defect in penis and resulting disturbance in ability to void standing up.
      4. Knowledge deficit related to condition, surgeries, outcome.
    4. Nursing care plan/implementation:
      1. Goal: promote normal urinary function.
        1. Teach family that surgery is done in several stages, beginning in the early months of life and finishing by age 18 months.
        2. Provide age-appropriate information to child regarding condition, surgery.
        3. Preoperative teaching with child: simulate anticipated postoperative urinary drainage apparatus and dressings on dolls; allow child to handle and play with them now, but stress need not to touch postoperatively.
        4. Postoperatively: Monitor urinary drainage apparatus; note hourly urine output, color, appearance (should be clear yellow, no blood).
      2. Goal: promote self-esteem.
        1. Do not scold child if he exposes penis, dressings, catheters, etc.
        2. Reassure parents that preoccupation with penis is normal and will pass.
        3. Encourage calm, matter-of-fact acceptance of, and avoid strict discipline for this behavior, which could affect the child negatively.
    5. Evaluation/outcome criteria:
      1. Child is able to void in normal male pattern.
      2. Child does not experience disturbances in self-concept and has normal self-esteem.