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Q. Will scar reopening after surgery cause urinary problem in hypospadias patient?


 

Hello doctor,

My son is 5 years old. He is born with hypospadias and had a stage 1 surgery to fix it back two years back. Everything went well so far. However, the following symptoms are now showing up. From the last week, he started to complain when passing urine saying it was stinging him. We went to GP and urine sample showed no infection. Since yesterday, drips of blood are there in his urine. We went to A and E and urine still showed no infection. However, the doctor advised seeing GP tomorrow to get a referral to a Urologist. The doctor is not sure what this could be due to mentioned that a scar could have reopened? Antibiotics prescribed to avoid potential infection? Could you please give us your feedback on these symptoms and let us know what kind of intervention is likely to happen if a complication was established? If it was a buildup of scar tissues or a urethral stricture for example, how would you treat it? We are deeply concerned as the first surgery was so painful and intense.


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Dr. Karthik Rajan
MCH UROLOGY., MS GEN SURGERY., MBBS
Andrology, Urology

Hi,

Welcome to icliniq.com.

I have gone through your query. I would like to know a few more details. You mentioned stage 1 surgery was performed two years back. When was the second stage done? Did he complain of any urinary problems after surgery? The most likely cause is an infection given his history is surgery, now that infection has been ruled out, other factors like bleeding from the surgical site have to be checked out. It is also possible that this may be totally unrelated to surgery, young children do sometimes get blood in the urine due to unexplained causes or calcium in urine, but given the history of surgery, the factors related to that have to be ruled out first.

Yes, it is possible to get a stricture after hypospadias repair, and that can also cause bleeding due to high pressure during urination, and it has to be checked out, even if there are no complaints. If it is established that it is a stricture, then the treatment will vary according to the location and severity. It can be endoscopic or repeat surgery or sometimes just dilatation would suffice. It is impossible to predict, without knowing the actual details about the previous surgery and without evaluation of the child now as to what treatment he will need.

 

Hi doctor,

Thank you for your precious feedback. We have no idea when the GP would refer us to a Urologist just yet and this could take a while so thank you again for taking the time to develop your views on the matter.

To respond to your question, he only had one surgery. The A and E doctor checked the healed area today and commented that the surgery was well performed. My son has been to the loo twice since we sent you the question online a few hours ago and we were relieved to see no blood as well as no pain was there. Now we are wondering if it was surgery related, do you think the initial burning pain and the blood would still remain or could it stop and come back like it seems to be the case now?

 

Dr. Karthik Rajan
MCH UROLOGY., MS GEN SURGERY., MBBS
Andrology, Urology

Hi,

Welcome back to icliniq.com.

It is nice to hear that your child is doing well. In my opinion, I would like to just make sure that the urinary flow is normal as of now, even though everything appears to be normal from the outside. It would not be necessary to perform any extensive testing now that your child has recovered well. If the flow is normal, it is unlikely that the problem now was related to the surgery. As I said before there are many reasons why children have some occasional blood in urine. It is because your child has had surgery, we first think of it to be the cause.

As the child grows, the urethra also normally expands. It is difficult to predict whether the problem would recur. If a doctor has examined him and has found the surgery to be well performed, it is highly unlikely. It is still important that you do not ignore minor problems and get them checked out early just to be sure.

 
 
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