For families, understanding what the normal post-circumcision or distal hypospadias repair healing process looks like can reduce stress and unnecessary emergency department (ED) visits following these surgeries. Arkansas Children's created postsurgical atlases for these delicate operations to ensure families receive the education they need to move forward with greater confidence and peace of mind.
A Guide to Post-Circumcision Healing
Expected to be ready by May 2023, the Arkansas Children's Hospital post-circumcision atlas will feature images and explanations of normal skin changes that occur at different stages of the healing process. The atlas will also include information about abnormal findings and when to notify the pediatric urologist.
Families will be able to access a digital version of the atlas through MyChart, the patient portal powered by the Epic electronic medical record system.
“Families should access the atlas in the recovery room so they can ask questions of the physicians and nursing staff before discharge, and then refer to it at home as needed when questions arise about their child’s healing,” said
Ashay Patel, D.O., chief of pediatric urology at Arkansas Children’s Hospital and associate professor in the Department of Urology at the University of Arkansas for Medical Sciences. “Families will benefit from the atlas by obtaining education and reassurance about normal and abnormal healing after a circumcision. This resource will also prevent unnecessary ED visits and calls to the clinic, which are time-consuming, expensive and stressful.”
Helping Ease the Burden of Healing Following Hypospadias Repair
At Arkansas Children's Hospital, four pediatric urologists performed 120 to 140 hypospadias repair surgeries in 2021 using the most up-to-date, evidence-based techniques. These complex operations often prompt a variety of concerns in families surrounding children's cosmesis, self-esteem, future sexual performance and voiding ability, according to Dr. Patel. In addition, parents or guardians must play an active, sometimes stressful role in the healing process.
"In the immediate postoperative period, the burden on families is high because the patients have a catheter that their parents have to take care of, as well as monitor urine output and prevent dislodgement of the catheter at home," Dr. Patel said. "In addition, many patients have a wound dressing that parents have to remove at home a couple of days after surgery. Finally, parents have to manage patients' pain at home, which may be higher due to the presence of a catheter. Parents often worry whether the surgical site is healing well and if the changes they're noticing are normal."
To help answer those questions and allay concerns, pediatric urologists created the Arkansas Children’s Hospital’s hypospadias repair atlas, which was integrated into the Epic system in October 2022.
Unique Imagery
Like the post-circumcision atlas, the hypospadias repair atlas is intended for families to consult in the recovery room following surgery and at home, as needed. The goals are to reassure parents, educate them about the normal healing process and prevent unnecessary medical visits and consultations.
"For families, our hypospadias repair atlas is unique because it contains postoperative images [obtained with parental consent] from surgeries performed by the same surgeons who operated on their son," Dr. Patel said. "This helps ensure the images in the atlas closely resemble their son's outcome because surgeons are, typically, quite consistent in the way they perform these operations."
In the future, as more pediatric urologists join Arkansas Children's Hospital, Dr. Patel advocates for updating the images in the atlas to reflect the new clinicians' approaches to suture, dressing and catheter use. These factors may affect the appearance of the surgical site during the healing process.
