You and your child will meet the anaesthetist on the day of the procedure. After talking to you and briefly examining your child, they will take you through to the operating theatre. One parent is welcome to accompany your child until they are asleep. To put your child to sleep the anaesthetist will use a face mask, or with children 5 years and over there is the option of either face mask or needle (with numbing cream). You will then be shown the waiting room where there is tea, coffee or water available to drink. Once your child is asleep, the anaesthetist will insert a ‘drip’ to allow fluids to be given directly into a vein. Usually this is located in the hand or arm, but occasionally may need to be sited in the leg or scalp. Some antibiotics are given into the drip to help prevent early infection. The anaesthetist will then inject some local anaesthetic to numb the penis. Usually this is injected near the base of the spine near the ‘tail’ bone, termed a ‘Caudal’. Please inform the anaesthetist if you wish to discuss the relative risks and benefits of this procedure.

The penis is cleaned with an antiseptic solution. A new urine tube will be created to the tip of the penis, usually using the inner layer of the foreskin. The remains of the foreskin are removed and any bleeding stopped with an electrical cautery instrument. Salty water is temporarily injected into the penis to make sure that it will be straight when erect. The wounds are then closed using a very fine purple or white stitch material that will dissolve slowly over the next 2 to 4 weeks. A fine white plastic tube is inserted into the penis so that urine will trickle out into the nappy after the surgery. This tube is secured with a bright blue stitch. A gauze dressing will cover the penis, held in place with clear plastic film. The local anaesthetic block usually lasts around 6 to 12 hours.

Your child will be taken to the recovery area after the surgery. Once they are awake, you will be called into the recovery ward. Often children appear distressed and a little confused initially – there may be several reasons for this including residual effects of the anaesthetic, hunger, and some discomfort. Generally they will settle quite quickly, especially if offered a drink or feed. The recovery and ward staff are also able to give pain relief medication once your child is awake, and this is sometimes required. The nursing staff will check the wound and make sure you are happy before you go home. Usually this will be about 2 hours after the surgery.

As a result of the local anaesthetic nerve block, your child may complain of a numb sensation in the groin and in some cases some weakness in the leg on the side of the surgery. This is temporary and will generally settle within a day or so of the operation.

Your child should not be bathed for the first 48 hours, but nappies can be changed as required and a ‘wet-wipe’ of similar cloth used. On the second post-operative day (48 hours after surgery) your child should have a bath at home and the dressing removed completely once it has been thoroughly soaked. This process is often made more comfortable by a dose of Painstop one hour before the bath. It is also very important to do this with two adults: one to look after the child and one to remove the dressing. Remember that the penis and scrotum will appear very bruised and swollen at this time. After the bath it is important to apply the tube of topical antibiotic cream (‘Chlorsig’) supplied to the wound 2 times a day for 1 week. In addition, to help prevent the tip of the penis from sticking to underpants or nappies, a thin layer of Vaseline or petroleum jelly is helpful.

Normal bathing is safe from the next day onwards. Often the penis will appear red, swollen and ulcerated in the first few weeks after surgery. This is normal and does not represent infection. The swelling improves considerably after the first few weeks but does not resolve completely for up to one year after surgery.

Your child can begin eating when he gets home. Start with clear liquids (apple juice, iceblocks) and add solid food slowly and in small amounts. Your child may vomit from the anaesthesia on the day of surgery. This should stop by the morning after surgery.
Your child can begin eating when he gets home. Start with clear liquids (apple juice, iceblocks) and add solid food slowly and in small amounts. Your child may vomit from the anaesthesia on the day of surgery. This should stop by the morning after surgery.