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Post-Operative Instructions

General Instructions

Diet

Your child will be started on clear liquids while still in the hospital or surgery center.  The diet can be advanced to regular diet as tolerated.  If vomiting occurs, return to the clear liquid diet and progress slowly. Anesthesia can cause nausea or vomiting in some patients for up to 24 hours after surgery.

Activity

General anesthesia can affect your child for 24 hours.  They may appear sleepy or fully awake. Either way they still need careful watching to prevent falls and accidents.

Bathing

In general, your child should stay out of the bathtub or shower for 2 days following surgery.  Sponge bathing is fine as long as the wound stays dry.  The time before your child can bathe will be longer if he/she has   a drainage tube or catheter.  Your doctor will provide you with specific instructions depending on the type of surgery your child had.

Wound Care

Your child will have skin glue covering the incisions (dermabond) which will flake off gradually as the skin underneath it heals. The stitches in the incision will dissolve on their own.

Medications

Your child will be prescribed Tylenol for pain if younger than 6 months old or Tylenol with codeine (or similar medication) for pain if > 6 months old

Return Appointment

Please call 352 273-9454 to schedule your follow-up appointment after surgery.

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Call for these symptoms

  • Noisy or difficult breathing
  • Fever over 101 degrees F or 38.4 degrees C
  • Persistent vomiting
  • Persistent bleeding or severe swelling of the penis or scrotum
  • Drainage (pus) from wound
  • Child is unable to urinate even after sitting in a tub of warm water
  • Painful urination that persists after 3 days
  • Any dressing concerns
  • Any problems, questions, concerns

If your child has any problems after surgery or you have any nursing related questions, please call our nursing line at (352) 273-7655 during normal business hours.  You may have to leave a message, but your phone call will be returned as quickly as possible.  If you have an urgent question please call (352) 265-8240 and ask to speak with the pediatric urology nurse.  If you are calling after hours, please call UF Health Shands Hospital at (352) 265-0111 and ask to speak to the Urology resident on call.  If you have an emergency, as always, go to your nearest Emergency Room or phone 911.

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Circumcision/Penoplasty Instructions

Topical Vaseline or Neosporin should be applied to the penis immediately after surgery every 3 hours, or with diaper changes.  Your child will have skin glue covering the incisions (dermabond) which will flake off gradually as the skin underneath it heals.  The glue will be crusty and can appear yellow or discolored with time.  The stitches will dissolve on their own.

It is normal for the penis to appear swollen and bruised.  Sometimes the swelling can appear asymmetric.  These findings will all resolve with time and usually appear much better at the end of the first week.  Your child should avoid swimming in a pool or lake water for 2 weeks after surgery.  Light activity is fine, but your child should not participate in sports for 2-3 weeks after surgery.

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Undescended Testicle Repair Instructions

Most children will have one incision in the groin and a second incision in the scrotum.  No topical care for the incisions is required.  The skin glue will gradually flake off and the stitches will dissolve as your child resumes their normal bathing activities.  It is normal for the scrotum to appear swollen and bruised around the scrotal incision.  These findings will all resolve with time and usually appear much better at the end of the first week.  Your child should avoid swimming in a pool or lake water for 2 weeks after surgery.  Light activity is fine, but your child should not participate in sports for 3-4 weeks after surgery.

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Hydrocele Repair Instructions

Most children will have one incision in the groin following hydrocelectomy.  No topical care for the incisions is required.  The skin glue will gradually flake off and the stitches will dissolve as your child resumes their normal bathing activities.  It is normal for the scrotum to appear swollen after surgery and slightly bruised.  The swelling can take several weeks to resolve depending on the size of the hydrocele and the extent of the repair.  Your child should avoid swimming in a pool or lake water for 2 weeks after surgery.  Light activity is fine, but your child should not participate in sports for 3-4 weeks after surgery.

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Meatotomy/Meatoplasty Instructions

There are no bathing restrictions following meatotomy.  Expect frequent urination the first few days.  It is often helpful to have your child urinate while sitting in a tub of warm water.  It is normal to see blood tinged urine the first 2-3 days.  If bleeding persists contact your doctor.  Care must be taken to keep the opening of the penis from sticking together and healing closed.  Apply Bacitracin or Neosporin Plus to the meatus to prevent it from sticking together.  The opening of the penis should be spread apart by placing your thumbs on each side and gently separating the skin.  This should be done every day for one week.

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Hypospadias Repair Instructions

Your child should avoid swimming in a pool or lake water for 2 weeks after surgery.  Light activity is fine, but your child should not participate in sports for 3-4 weeks after surgery.  For infants, straddle toys (ie. Johnny jump-up, saucer seat, bouncy chairs etc.) should be avoided for 2 weeks after surgery.  They can put undo pressure or tension on the repair that might affect the healing process.

Your child should stay out of the bathtub or shower for 3 days following surgery.  Sponge bathing is fine as long as the wound stays dry.  After 3 days, your child can bathe/shower.  While it is not advisable to submerge the stent in bath water, it is OK if some water gets into the stent.

Your child may have a drainage tube after surgery (stent or catheter).  Urine should drain continuously from the tube.  If drainage stops, please notify the surgeon immediately.  If your child does not have a tube, he may have trouble voiding.  It is not uncommon for a child to wait to void until after midnight following surgery.  Urine may be blood tinged.

The penis will be wrapped in a clear plastic dressing that provides compression to the penis to prevent bruising and swelling.  Normally, the dressing will stay in place until you return for your post-operative visit.  It is OK if the dressing appears loose or baggy, however, if you notice that the dressing is only covering half of the penis (ie. It has rolled from the top of the penis down toward the middle, or up from the bottom of the penis toward the middle), the dressing can become constricting in these circumstances (like a tourniquet) and needs to be removed.  In order to remove the dressing, the anchoring flaps of tape on the abdominal wall and scrotum can gently be pulled up toward the tip of the penis.  The dressing should gradually telescope off the penis.  If you have trouble or are not sure if the dressing should be removed please call the nursing line.  You should not remove the clear plastic covering around the penis under any other circumstances unless directed by your doctor.

The penis should be placed upwards towards the abdomen (if dressing permits) when diapering your child.  Diapers should be fastened loosely.

At your post-operative appointment (7-14 days after surgery), your doctor will remove the dressing and the drainage tube.  Occasionally, the dressing will fall off before your appointment.  This is not cause for concern.  Once the dressing is removed (or falls off) you will need to begin applying Vaseline or Neosporin to the penis and incisions liberally every 3 hours, or with diaper changes.  It is normal for the penis to appear very bruised and somewhat swollen after hypospadias surgery.  Sometimes the swelling can appear asymmetric.  These findings will all resolve with time and usually appear much better after 1 to 2 weeks.  Your child will have skin glue covering the incisions (dermabond), which will flake off gradually as the skin underneath it heals.  The glue will be crusty and can appear yellow or discolored with time.  You may also see some steri-strips on the penis, which will fall off gradually.  The stitches will all dissolve on their own.  Please do not attempt to remove the glue or steri-strips from the penis.  Attempts to remove this material prematurely might pull out some stitches that are necessary for proper healing of the penis.

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Cystoscopy Instructions

There are no bathing or activity restrictions following cystoscopy.  Frequently patients will experience burning and pain with urination the first few days.  It is often helpful to have your child urinate while sitting in a tub of warm water.  Blood tinged urine may be noted for the first 2-3 days, this is normal.  If bleeding persists, or your child is unable to urinate or has persistent painful urination, you need to contact us.

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Ureteral Reimplantation Instructions

If your child does not have an external drainage tube (ureteral stent), they can bathe or shower 2 days after surgery.  Sponge bathing is recommended until the external drainage tube is removed.  After removal of the tube, you might notice some leakage of urine from the skin site.  This should seal spontaneously within 24 – 48 hours.  Bathing can resume once this skin site has sealed.  Your child may experience urinary frequency, urgency, incontinence, cramping (bladder spasms) and persistent blood in the urine after surgery.  These symptoms improve gradually and generally resolve within 2-3 weeks of surgery.  If your child has persistent nausea/vomiting, flank or abdominal pain, fevers, poor appetite, or significant blood in the urine, you should contact us.

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Pyeloplasty Instructions

If your child does not have an external drainage tube, your child can bathe when you are discharged from the hospital as soon as the drain site is dry.  Most children will be discharge with an internal stent extending from the kidney down into the bladder.  An appointment will need to be arranged to have this removed 4-6 weeks after surgery.  In most children, this will be done under anesthesia, although no incision will be required.  One month following stent removal, your child will need to be re-scheduled for an appointment with your surgeon with a repeat renal ultrasound and renal scan.  Please call (352) 273-9454 to make those arrangements.  You need to contact us if your child has significant flank pain, nausea/vomiting, or fevers following the pyeloplasty or stent removal.
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