Hypospadias repair, post-op pharmaceutical management

exp date isn't null, but text field is

Objectives

To provide a consistent and safe approach to the pharmaceutical post-operative management of patients following hypospadias repair.

Scope

Applies to all patients following hypospadias repair within The Royal Hospital for Children Glasgow.

Audience

Roles and Responsibilities

All health care professionals providing medicines for the postoperative management of patients following hypospadias repair.

1. Repair with stent e.g TIP/Snodgrass or Staged Repair Post- operative Pharmaceutical Care Pathway

Duration of treatment is for the duration the stent remains in place. This is usually 7 days although may be ten days depending on the day surgery falls upon.

If stent is suprapubic duration of treatment may be extended as per surgical consultants instruction.

1.1 Prophylactic Antimicrobials

Antimicrobial prophylaxis is recommended in all patients with a stent. Co-amoxiclav is a broad spectrum antibiotic that will cover the patient from several organisms.

Co-amoxiclav (Augmentin) 125/31 suspension

Age

Dose

Frequency

1 month – 1 year   

0.25mL/kg (125/31 suspension)

Once daily at night

1 – 5 years

5mL of 125/31 suspension

Once daily at night

Co-amoxiclav (Augmentin) 250/62 suspension

Age

Dose

Frequency

>5 years   

5ml of 250/62 suspension

Once daily at night

Trimethoprim

If the patient has a history of UTI’s, is at a higher risk of UTIs or is allergic to penicillin, prophylactic Trimethoprim may be prescribed where appropriate. Dose for all ages is 1-2mg/kg at night.

 

1.2 Prophylaxis of Bladder Spasm

Oxybutynin 2.5mg/5ml elixir

The prescriber must check the patient’s weight is appropriate for age before prescribing.

Weight        

Dose

<10kg

0.2mg/kg

10 – 14kg

2mg three times daily

15 – 25kg

2.5mg three times daily

>25kg

5mg three times daily

1.3 Analgesia

Paracetamol 120mg/5mL suspension

For first 48 hours paracetamol should be given regularly, after which time ‘when required’ paracetamol should be prescribed.

Refer to current BNFc for age based dosing of paracetamol

Ibuprofen 100mg/5mL suspension

If appropriate and required, prescribe ‘when required’ for all patients.

Refer to current BNFC for age based dosing of ibuprofen

1.4. Constipation

Lactulose solution

If patient has history a of constipation or is suffering with symptoms of constipation lactulose should be prescribed when required.

Age

Dose

<1 year

2.5mL twice daily

1 - 5 years

5mL twice daily

5 - 10 years   

10mL twice daily

Adjust dose according to response.

1.5 Saline Flush

Staged repairs may also require the use of Normal Saline 0.9% for twice daily flushing of the catheter. Prescribe if appropriate for patient.

2. Hypospadias Repair with no stent Pharmaceutical Care Pathway

Duration of treatment 5 - 7 days.

 

2.1 Antimicrobials

Unless surgery is extensive antimicrobial prophylaxis is not recommended. If surgery is thought to be extensive and patient at a high risk of infection, Co-amoxiclav should be prescribed as above in section 1.1.

2.2 Prophylaxis of bladder spasm

Without the use of a catheter oxybutynin is not required.

2.3 Analgesia

Paracetamol and Ibuprofen should be prescribed if required as above in section 1.3.

2.4 Constipation

If required lactulose should be prescribed as above in section 1.

Editorial Information

Last reviewed: 09 January 2018

Next review: 01 January 2021

Author(s): Stuart O'Toole

Version: 3

Co-Author(s): Shahad Abbas, Pharmacist

Approved By: Paediatric Drugs & Therapeutics Committee