When Does Hypospadias Repair Need a Second Operation? Fistula, Narrowing and Revision

The first sign is often nothing dramatic. A father lifts his son out of the bath, the toddler pees with delight, and two thin streams appear where there used to be one. Or a mother notices a damp spot on the underwear that never seems to come from the tip. Six months earlier, the hypospadias surgery had gone smoothly. Now there is a question nobody warned them to expect: does this mean another operation?

For many families it does, and the phrase they soon hear is hypospadias fistula repair. It sounds alarming. In practice it is one of the most common and most predictable follow-up procedures in pediatric urology, and understanding why it happens takes much of the fear out of it.

This explainer walks through the three reasons a hypospadias repair is most often revisited: a fistula, a narrowing, and a broader revision. It covers what actually happens in the operating room, who is asked to wait, what the weeks afterward look like, and the signs that should prompt a call to the care team.

What is hypospadias fistula repair, and why might your child need it?

Hypospadias is a difference present at birth in which the urethral opening, the hole urine comes out of, sits on the underside of the penis rather than at the tip. The CDC estimates it affects roughly 1 in every 200 boys born in the United States, which makes it one of the more common structural differences a pediatrician sees. Surgery moves the opening to the tip by building a new section of urethra out of nearby skin and lining tissue.

That new tube is remarkable and fragile at the same time. In a toddler it is only a few millimeters wide, roughly the diameter of a drinking straw, and in its first weeks it survives on blood supply borrowed from surrounding tissue rather than any circulation of its own. Where healing falters at one point along the suture line, a tiny channel can open between the inside of the new urethra and the skin surface. That channel is a fistula. Hypospadias fistula repair is the operation that closes it.

MedlinePlus lists fistula, narrowing of the urethra and narrowing of the opening among the recognized complications of hypospadias repair. The word complication can sound like a verdict on the first surgery, but surgeons and guideline bodies treat these outcomes as a known part of the pathway rather than an error. The tissue being asked to heal is thin, it is bathed in urine several times a day, and a child cannot be persuaded to keep still for two weeks.

What matters most for parents is this: a fistula is not dangerous in itself, it is not a sign the repair has failed as a whole, and it is usually fixed in a shorter, simpler procedure than the original. The rest of this article explains how that unfolds.

Why do some hypospadias repairs need a second operation at all?

Ask any reconstructive surgeon what makes hypospadias hard and the answer is rarely the anatomy. It is the healing environment. Urine passing through a freshly stitched tube several times a day acts a little like water running through a newly grouted tile joint before it has set. Most of the time the seal holds. Occasionally it does not.

Several factors nudge the odds. The more severe the original hypospadias, meaning the farther back along the shaft the opening started, the longer the new urethra has to be and the more suture line there is to heal. Mayo Clinic notes that repair of a more severe form may be staged into two operations from the start, which is planned surgery rather than a complication. Poor blood supply to the local tissue, infection, swelling under the skin, or a catheter that blocks or slips out early can each stress the repair.

Children also do what children do. A two-year-old who tugs at a dressing or takes a tumble in the first week is not to blame, but it is one more reason surgeons prefer to operate before a child is fully mobile and after the penis has grown enough to work on. MedlinePlus places the usual window for the first repair between 6 months and 2 years of age.

The honest summary is that second operations are common enough that every family should be told about them beforehand, and uncommon enough that most children will never need one. Guideline sources deliberately avoid quoting a single figure because rates vary widely with severity, technique and how long a child is followed. If your surgeon gives you a number, ask what population it comes from.

What is a urethrocutaneous fistula after hypospadias?

The full name is urethrocutaneous fistula, which simply means a passage from the urethra (urethro) to the skin (cutaneous). It is the single most talked-about hypospadias complication and, for parents, the easiest to spot.

The classic sign is a second stream of urine, usually from the underside of the penis, often near the join between the original opening and the newly built section. Sometimes it is a spray rather than a stream, or a drip that only shows up as wet underwear. A fistula the size of a pinhead can be surprisingly noticeable because urine is under pressure when a child voids.

Timing varies. Some fistulas are obvious as soon as the catheter comes out. Others appear weeks later once swelling settles, and a few are only noticed when a boy is old enough to stand at the toilet. This is why most urology teams keep children under review well beyond the immediate recovery period rather than signing them off at the first check.

A fistula is not painful, does not cause infection in most cases, and does not damage the kidneys. What it does is undermine the purpose of the original surgery: a single, forward-directed stream that lets a boy stand to urinate like his peers. That functional and social goal, not danger, is the reason it is repaired.

Very small fistulas occasionally close on their own in the early weeks, which is one reason surgeons watch and wait rather than rushing back. Beyond that early period, a fistula that persists is very unlikely to seal without help, and the question becomes when, not whether, to operate. MedlinePlus and Mayo Clinic both describe fistula as a recognized outcome that may require an additional procedure.

What is meatal stenosis after hypospadias repair, and how is narrowing different?

Meatal stenosis is a narrowing of the meatus, the opening at the tip of the penis. Stricture is a narrowing farther down inside the urethra. Both can follow hypospadias repair, and both work the same way a kinked garden hose does: the flow does not stop, it just becomes thin, forceful, or aimed in the wrong direction.

Parents notice different things than doctors do. A stream that shoots upward or off to one side, a boy who strains or takes a long time to empty, dribbling after finishing, or a very narrow, high-pressure jet are the common observations. MedlinePlus describes a thin or strong stream, spraying and discomfort as typical features of meatal stenosis in boys generally, and the picture after hypospadias surgery is similar.

Why does it happen? Scar tissue contracts as it matures. Where the new urethra was joined to the tip, that contraction can pull the opening smaller over weeks or months. Farther inside, an area of reduced blood supply along the reconstructed tube can heal with a firm ring of scar that resists stretching.

Narrowing is treated differently from a fistula. A tight meatus is sometimes managed with a minor procedure to widen the opening, occasionally under local anesthetic in older boys. A stricture deeper in the urethra may need to be assessed with a scope, opened, or in some cases rebuilt as part of a broader revision. Untreated, significant narrowing matters more than a fistula because it forces the bladder to work harder, so teams tend to act on it rather than observe indefinitely.

The two problems also sometimes travel together. Pressure building behind a narrowing can stress a weak point in the suture line and open a fistula, which is why a surgeon assessing one will always check for the other.

When is hypospadias revision surgery about more than a fistula?

Hypospadias revision surgery is the broad term for going back to correct any part of the original repair, and fistula and narrowing are only two items on the list. Recognizing the others helps families understand why one child has a quick outpatient fix while another is offered a staged rebuild.

Glans dehiscence is the separation of the two halves of the head of the penis that were stitched around the new opening. The result is an opening that has slipped back toward its original position. Depending on how far it has moved and how the stream behaves, some teams accept a slightly lower opening; others recommend redoing the tip.

A diverticulum is a balloon-like outpouching of the reconstructed urethra. It forms when a segment of the new tube is wider than the segments around it, often because of a narrowing downstream. Urine pools in it, the penis may bulge during voiding, and dribbling afterward is common. Correction usually means trimming the excess and addressing whatever narrowing caused it.

Residual curvature, called chordee, is a downward bend that was either not fully straightened at the first operation or has developed as scar tissue matured. Mayo Clinic lists straightening of the penis as one of the core goals of hypospadias surgery, so a persisting bend is a legitimate reason to revisit.

Skin problems round out the list: excess skin on one side, a tethered scar, or hair-bearing skin that was used in the urethra and later causes trouble. Each is real but each is also very individual, which is why revision plans are built around the specific child rather than a standard menu. The treating team decides which findings justify surgery and which are best left alone.

How does hypospadias fistula repair actually work?

Picture a small hole in the inner tube of a bicycle tire. You would not simply stick a plaster over the outside and expect it to hold under pressure. You would find the edges, close the hole itself, and then cover the patch with something stronger. Hypospadias fistula repair follows the same logic, in three layers.

First, the surgeon finds the tract. A fine probe passed through the skin opening confirms where it enters the urethra; some surgeons also fill the urethra with dyed fluid to reveal a second, smaller fistula nearby that would otherwise be missed. Missing one is the classic reason a fistula seems to come back.

Second, the tract is cut out entirely and the urethral wall is closed with fine dissolving stitches. Leaving even a sliver of the old tract behind gives the leak a route to reopen, so the edges are trimmed to healthy tissue. The closure is tested by gently filling the urethra to check nothing seeps.

Third, and this is the part that most distinguishes a durable repair from a flimsy one, a layer of well-supplied tissue is brought over the closure. Surgeons usually use dartos, the thin, stretchy layer beneath the penile skin, or a similar local flap. It acts as a waterproofing barrier between the urethral stitches and the skin stitches. The skin is then closed so that its suture line does not sit directly over the urethral one, the way a builder staggers bricks rather than stacking joints.

A small catheter may be left to divert urine for a period of days while the layers knit, though many surgeons omit it for simple fistulas. Both approaches are described in mainstream practice, and the choice rests with the operating team.

Who is usually offered repair now, and who is asked to wait?

The instinct, when a child is leaking urine from the wrong place, is to fix it immediately. Surgeons almost always resist that instinct, and the reason is worth understanding because waiting can feel like neglect.

Freshly operated tissue is stiff, swollen and richly scarred for months. Suture lines placed into that tissue hold poorly and blood supply to any new flap is unreliable. If a surgeon operates too early, the risk of the repair breaking down again rises sharply. Waiting until the penis feels soft and mobile, with scars that have faded and flattened, gives the new closure a far better environment. For most children that means the fistula is observed through the first several months after the original surgery, with the exact interval judged by the surgeon on examination rather than a fixed calendar.

Children generally offered repair once that maturation has happened include those with a persistent fistula that produces a clear second stream, those with a fistula plus a narrowing, and those whose leak is affecting toilet training or schooling. Older boys who have lived with a small leak for years and now want it addressed are also candidates.

Families usually asked to wait, or to observe rather than plan surgery, include those whose fistula is only a few weeks old and may still seal, those whose child has an active skin infection or diaper rash over the area, and those where the leak is tiny and the child and parents are untroubled by it. Some very small fistulas are reasonably left alone indefinitely if they cause no problem. The decision balances how much the leak matters against the risks of another anesthetic, and it is one for the family and the treating urologist together.

Fistula, narrowing and revision compared: what parents notice and what surgeons do

Three problems, three quite different experiences. The table below summarizes what families typically observe, when the issue tends to show itself, and the general nature of the fix. None of it replaces an examination; several of these problems mimic each other and often coexist.

Problem	What a parent may notice	When it usually appears	Typical approach
Urethrocutaneous fistula	Second stream or drip from the underside of the penis; wet underwear from a spot other than the tip	Soon after the catheter is removed, or weeks to months later once swelling settles	Observe early; if it persists, excise the tract and close in layers with a waterproofing flap
Meatal stenosis (tight tip)	Thin, forceful stream; spraying upward or sideways; straining; long time to void	Weeks to months later as scar tissue contracts	Minor widening of the opening; sometimes a small local procedure
Urethral stricture (deeper narrowing)	Weak or interrupted stream; pushing to empty; dribbling; bulging along the shaft	Months to years later	Assessment with a scope; opening or rebuilding the narrowed segment
Glans dehiscence	Opening has slipped back from the tip; head of penis looks split	Usually in the first weeks	Accept if mild and functional; redo the tip if the stream or appearance is affected
Diverticulum	Balloon-like swelling during voiding; post-void dribbling	Months later, often with a downstream narrowing	Trim the pouch and treat the narrowing that caused it
Residual curvature	Downward bend visible with erections	Any time; more obvious with growth	Straightening as part of a planned revision

Two patterns are worth pulling out. Problems that appear in the first weeks tend to be about the repair not holding; problems that appear months or years later tend to be about scar tissue tightening. And anything that produces a bulge or a struggle to empty deserves prompter attention than a simple leak, because it points to obstruction. Mayo Clinic and MedlinePlus both describe fistula, stricture and meatal narrowing as the recognized complications that may need further surgery.

Is fistula repair a major surgery, and how painful is it?

Two of the questions parents type into a search bar most often are whether this counts as a major operation and how much it hurts. Both deserve straight answers.

Compared with the original hypospadias repair, a simple fistula closure is a smaller procedure. It involves a short incision, work confined to one small area, and typically shorter operating time. Most children go home the same day. It is still surgery under general anesthesia, which means the usual preoperative checks, a period of fasting, and the small but real risks that come with any anesthetic in a young child. Calling it minor undersells the preparation involved; calling it major overstates the operation itself. A more extensive revision, such as rebuilding a length of urethra or correcting curvature, sits closer to the original surgery in scale and may involve a catheter and a longer recovery.

On pain, the honest picture is reassuring. The penis has a rich nerve supply, so the first day or two can be uncomfortable, particularly when the child voids or when a dressing is changed. Discomfort is usually described by parents as fussiness and reluctance to be handled rather than distress, and it settles quickly. Anesthetic teams commonly use a regional nerve block during surgery so the child wakes with the area already numbed for several hours. Afterward, pain is managed with medicines chosen and dosed by the team caring for your child, and it is their instructions, not this article, that should guide what you give at home.

Bladder spasms, sudden cramps that make a child cry out briefly, can occur if a catheter is in place. They are unpleasant but short-lived, and the team will explain how they manage them. Older boys sometimes describe the healing skin as itchy rather than painful by the end of the first week.

What do the days and weeks after hypospadias fistula repair usually look like?

Recovery is quieter than most parents expect, though the first days need attention.

The first 48 hours: expect swelling and some bruising, which can look dramatic on a small child. A dressing may be in place, and the team will tell you whether it comes off at home or in clinic. If a catheter has been left in, it drains into a diaper or a small bag; keeping it from being pulled is the main job. Double-diapering, with the catheter tunneled into an outer diaper, is a common technique the nursing team may show you. Sponge baths rather than tub soaks are usual until you are told otherwise.

The first week: the child is typically back to normal eating and mood within a couple of days. Straddle toys, bicycles and rough play are avoided to protect the repair. The MedlinePlus hypospadias repair guidance describes catheters staying in for a period of days up to about two weeks depending on the operation, and simple fistula closures often need none at all. If a stitch appears at the skin surface, it is usually dissolving and will fall away.

Weeks two to six: swelling subsides, scars go from red to pink, and normal bathing resumes when the team advises. The moment you have been waiting for, watching a single clean stream, comes now. Some spraying in the first weeks is common while the tissues settle and does not by itself mean failure.

Longer term: follow-up continues because narrowing can develop as scars mature. Many teams review at a few months and again after toilet training, when a boy stands to void and any stream problem becomes obvious. Keep those appointments even if everything looks perfect.

How common are fistulas in men, and are urethral fistulas like anal or obstetric ones?

Search for fistula and most of what comes back is about the bowel, the heart or childbirth injury. The word covers all of them because a fistula is simply an abnormal connection between two surfaces that should not communicate, as MedlinePlus defines it. That shared name causes real confusion for parents reading about their son.

Anal fistulas connect the anal canal to the skin near the anus and usually follow an abscess. Obstetric fistulas connect the bladder or rectum to the vagina after prolonged, obstructed labor and are a major cause of suffering in low-resource settings, as the WHO has documented. Atrioesophageal fistulas are a rare and dangerous complication of certain heart procedures. None of these has anything to do with the tiny skin-to-urethra channel that follows hypospadias surgery beyond the shared mechanism of tissue failing to heal as a sealed surface.

How common are fistulas in men more broadly? There is no single population figure because the category is so diverse. Urethral fistulas in adult men are uncommon and almost always secondary to something else: prior surgery, radiation therapy for prostate cancer, pelvic trauma, longstanding stricture disease, or infection. Spontaneous urethral fistula in an otherwise healthy adult is rare enough to be a case report.

In boys, the picture is dominated by hypospadias repair, precisely because the operation creates a long fresh suture line in a urine-bearing tube. This is why pediatric urologists think about fistula constantly and adult urologists rarely do. If you take one message from the broader fistula literature, let it be this: the frightening stories you read about other fistulas describe different organs, different causes and different stakes. A hypospadias fistula is a repairable leak, not a life-altering injury.

How is a male urethral fistula repaired when the cause is not hypospadias?

Parents of older boys and adult men sometimes arrive at this topic from a different direction: a urethral fistula after trauma, infection or another operation. The principles overlap with hypospadias fistula repair, but the scale and the surrounding tissue can be very different.

The first step is always to work out why the fistula exists. A fistula that sits downstream of a narrowing is under pressure every time the bladder empties, and closing the hole without fixing the narrowing invites recurrence. Surgeons therefore examine the whole urethra, often with a flexible scope or a contrast study in which dye is injected and imaged, before planning repair. In hypospadias children this assessment is usually simple; in adults with scar from radiation or trauma it can be the hardest part.

The repair itself follows the same three-layer logic already described: remove the tract, close the urethra with fine dissolving stitches, and interpose a well-supplied layer of tissue between urethra and skin. In adults, where local tissue may be scarred or damaged, that intervening layer might be a flap of tissue from the scrotum or a graft from the inside of the cheek, which is durable in a urine environment. Urine is usually diverted with a catheter while the repair heals, for longer than in a simple pediatric case.

Complex fistulas, particularly those that involve the rectum or follow radiation, may be staged over more than one operation and sometimes involve a temporary diversion of urine or stool. These are specialist reconstructions and the plan is highly individual.

What unites all of these is the same honest message: fistula repair works by restoring a sealed, well-vascularized wall, and the surgeon’s craft lies in choosing tissue that will heal in a hostile, wet environment.

What people often get wrong about hypospadias complications

Because so little of this is discussed openly, myths fill the gap. A few deserve direct correction.

The first surgery must have been botched. Not so. Fistula and narrowing are described by MedlinePlus, Mayo Clinic and the NHS as recognized complications of hypospadias repair, listed alongside bleeding and infection in the standard consent conversation. They reflect the biology of healing a thin tube bathed in urine, not a slip of the scalpel. Skilled surgeons see them; that is why they follow children for years.

The fistula will heal if we just keep it clean. Very small, very early fistulas occasionally seal. Beyond the first weeks, a mature fistula lined with skin-like cells does not close on its own however clean it is kept. Watching a persistent fistula is a decision to accept it, not a treatment.

Spraying means the repair has failed. Some spraying in the early weeks is common as swelling resolves. Spraying that persists or worsens deserves assessment for narrowing, but a single wayward stream in week two is not cause for alarm.

A second operation means a lifetime of operations. Most children who need one revision need only one. A minority, usually those with severe original hypospadias or repeated breakdown, follow a longer path. That is a discussion to have with your team, not an assumption to make at home.

He will have problems with sex or fertility. Hypospadias itself, in its common forms, does not affect fertility. Sexual function in adulthood is generally reported as normal for men whose repairs were straightforward, and even those with more complex histories are followed with that outcome in mind. Cosmetic differences are far more common than functional ones.

Waiting is the same as doing nothing. Waiting for scar to soften is an active surgical decision with a clear rationale: a repair into mature tissue is far more likely to hold than one into inflamed tissue.

Questions to ask your care team before hypospadias revision surgery

A good consultation leaves you knowing not just what will be done but why, and what the alternatives were. These questions tend to open the most useful conversations.

• Exactly what has gone wrong, and is it one problem or more than one? Fistulas and narrowing frequently coexist, and the plan differs if both are present.
• Why are you recommending this timing? Ask what you should look for in the interval and what would prompt an earlier review.
• What technique do you plan to use, and what tissue will cover the repair? A surgeon who can describe the waterproofing layer in plain language has thought carefully about durability.
• Will there be a catheter, and if so, roughly how long? How do we manage it at home, and what do we do if it blocks or comes out?
• What is the likelihood that this will need to be done again, based on children like mine? Ask where that figure comes from.
• What will pain relief involve, and who do we contact if he seems to be in more discomfort than expected?
• Are there activities he must avoid, and for how long? Ask specifically about nursery, car seats, straddle toys and swimming.
• What does a good result look like at the follow-up visit, and what would make you worry?
• How long will you keep seeing him, and what should we watch for once he is standing to urinate?
• If we chose not to operate, what would happen? A tiny asymptomatic fistula and a tight meatus have very different answers.

Write the answers down. Parents routinely report remembering less than half of what was said in a surgical consultation, and the details about catheters and activity restriction are the ones that matter at two in the morning. Every one of these decisions sits with the team examining your child; the questions simply make sure you understand their reasoning.

When to call your doctor after hypospadias surgery or fistula repair

Most recovery worries turn out to be ordinary swelling, a bit of blood-tinged urine in the first days, or a fussy child. A few signs are different and should prompt a same-day call to the urology team or, if they are unavailable, an urgent care assessment.

Seek care promptly if your child has not passed urine for a period the team has told you is too long, or if a catheter has stopped draining, has come out, or is leaking heavily around its edges. Inability to pass urine is the single most time-sensitive problem after any urethral surgery because the bladder is filling behind an obstruction.

Call the same day for fever, which the team will define for you in the discharge instructions; spreading redness, warmth or a foul-smelling discharge from the wound; bleeding that soaks through a dressing or does not stop with gentle pressure; or a penis that becomes dusky, purple or very tight and shiny rather than simply swollen. Sudden severe pain that is not relieved by the measures the team advised, persistent vomiting, or a child who is unusually drowsy or floppy also need urgent review.

In the weeks and months afterward, contact the team, though not as an emergency, if you notice a new second stream, a stream that becomes progressively thinner or sprays upward, obvious straining or a long time spent emptying, a bulge along the shaft during voiding, or dribbling that continues after he finishes. These are the signs of fistula, narrowing or diverticulum described earlier, and they are best assessed early.

When in doubt, call. Surgical teams would far rather hear about a normal bruise than miss a blocked catheter, and no parent has ever been criticized for checking.

Frequently asked questions

How painful is a hypospadias fistula repair for a child?

Discomfort is usually mild to moderate for the first day or two and settles quickly. Anesthetic teams commonly use a regional nerve block so the child wakes with the area numbed for several hours, and pain relief afterward is chosen and directed by the treating team. Parents typically describe fussiness and reluctance to be handled rather than distress. Bladder spasms can occur if a catheter is in place and are brief. Follow the discharge instructions exactly for any medicine at home.

Is fistula repair a major surgery?

A simple hypospadias fistula closure is a smaller operation than the original repair: a short incision, work in one small area, and usually a same-day discharge. It still requires general anesthesia and the standard preoperative preparation, so it is not trivial. A broader revision that rebuilds part of the urethra or corrects curvature is closer in scale to the first surgery and more often involves a catheter and a longer recovery period.

How common are fistulas in men?

There is no single figure because fistula is an umbrella term for any abnormal connection between two surfaces, as MedlinePlus describes. Urethral fistulas in adult men are uncommon and almost always follow surgery, radiation, trauma, longstanding stricture or infection. In boys, most urethral fistulas relate to hypospadias repair. Anal and obstetric fistulas are entirely different conditions that happen to share the name.

How is a male urethral fistula repaired?

The surgeon identifies the tract with a fine probe or dyed fluid, cuts it out completely, and closes the urethral wall with fine dissolving stitches. A layer of well-supplied tissue, often the dartos layer beneath the penile skin or a local flap, is then placed over the closure as a waterproof barrier, and the skin is closed so its suture line is offset from the urethral one. A catheter may divert urine for a period of days while it heals.

What causes a urethrocutaneous fistula after hypospadias surgery?

A fistula forms where one point along the new urethral suture line fails to seal, usually because of reduced blood supply, swelling, infection, a blocked or dislodged catheter, or pressure from a narrowing farther downstream. More severe original hypospadias means a longer reconstructed tube and more suture line at risk. It reflects the difficulty of healing a thin tube bathed in urine rather than a surgical mistake.

Can a hypospadias fistula close on its own?

Very small fistulas that appear in the first few weeks occasionally seal as swelling settles, which is one reason surgeons observe before acting. A fistula that persists beyond that early period has usually become lined with skin-like cells and will not close spontaneously however carefully it is kept clean. At that stage the choice is between accepting a small leak and planning a repair once the tissues have matured.

How long do surgeons wait before hypospadias revision surgery?

Most surgeons wait until the penis feels soft and mobile and scars have faded and flattened, which typically means a number of months after the original operation rather than weeks. The exact interval is judged on examination by the treating urologist, not a fixed calendar, because closures placed into stiff, inflamed tissue break down far more often. Narrowing that causes straining may be addressed sooner because it obstructs flow.

What are the signs of meatal stenosis after hypospadias repair?

Parents usually notice a stream that is thin, forceful, or shoots upward or sideways, a boy who strains or takes a long time to finish, and dribbling afterward. MedlinePlus describes a narrow or strong stream, spraying and discomfort as typical features of meatal stenosis in boys. These signs tend to appear weeks to months after surgery as scar tissue contracts and should be reported to the urology team for assessment.

What are the most common hypospadias complications overall?

MedlinePlus and Mayo Clinic list fistula, narrowing of the urethra or its opening, and the general surgical risks of bleeding and infection. Less common issues include separation of the glans around the new opening, a balloon-like outpouching called a diverticulum, residual downward curvature, and skin irregularities. Several can occur together, which is why surgeons assess the whole repair rather than treating one finding in isolation.

Will a second operation affect my son's fertility or sexual function later?

Common forms of hypospadias do not affect fertility, and a fistula repair or minor revision does not change that. Adult sexual function is generally reported as normal for men whose repairs were straightforward, and cosmetic differences are far more common than functional ones. Boys with severe original hypospadias or repeated breakdown are followed into adolescence with these outcomes in mind, and the treating team can discuss what applies to your child.

References

• MedlinePlus: Hypospadias repair
• CDC: About Hypospadias
• MedlinePlus: Meatal stenosis
• MedlinePlus: Fistula

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.