A nurse is caring for a 9-month-old infant who underwent surgical repair of hypospadias 2 days ago. Which nursing intervention is most appropriate for this patient?

Maintaining the urethral stent and monitoring urinary output are essential to ensure patency and prevent complications like obstruction or infection after hypospadias repair. Other interventions may be harmful or less critical.

Post-operative care for infant with hypospadias repair

The most appropriate nursing intervention for a 9-month-old infant two days after hypospadias repair is to maintain the urethral stent and monitor urinary output. The primary goal of post-operative care during this acute phase is to protect the surgical site, ensure urinary diversion to allow the neourethra to heal, and facilitate effective wound recovery. The urethral stent serves as a mold for the newly constructed urethra and diverts urine away from the suture line, reducing the risk of complications such as urethrocutaneous fistula and wound dehiscence ^[4]. Accidental dislodgement or blockage of the stent can lead to urinary extravasation and tension on the repair, directly contributing to these adverse outcomes.

Monitoring urinary output is a critical nursing responsibility because it confirms stent patency. A sudden decrease in output or the appearance of urine leaking around the stent indicates obstruction or dislodgement, requiring immediate intervention. Research on post-operative care pathways emphasizes that optimizing outcomes after hypospadias repair depends heavily on high-quality nursing care, which includes the timely identification of early warning signs related to stent function and wound integrity ^[4]. The nurse must meticulously document urine output, assess for signs of bladder distention, and ensure the drainage system remains dependent and free of kinks.

The other options are contraindicated in the early post-operative period. Removing the urethral catheter or stent prematurely would disrupt the healing process; studies on stent management describe the stent and dressing remaining in situ for a defined period, such as 6 days post-procedure, to allow for initial wound healing before removal ^[1]. Encouraging frequent diaper changes every hour is insufficient as a sole intervention and can inadvertently disturb the surgical site. Furthermore, applying tight diapers is explicitly harmful. The post-operative dressing must be protective, not compressive. Research on dressing methods demonstrates that using a combination of a non-adherent, moisture-protective layer like an antimicrobial incise drape and ointment is effective for wound recovery, whereas tight bandaging or compression can compromise vascular supply and increase the risk of ischemia and wound dehiscence . The standard of care involves placing two diapers—an inner diaper to collect stool and an outer diaper to contain urine from the stent—to prevent cross-contamination without applying direct pressure to the phallus.