Introduction: According to EAU's guidelines, hypospadias (HS) repair is best performed between 6 and 18 months of age. Little is known about the long-term patient satisfaction or urological outcome following HS surgery.
Aims: To examine the psychosexual and urological outcome of young adult men (16-21 years old) born with all forms of non-syndromic HS as compared to healthy controls, as well as patient and parental satisfaction following HS surgery.
Methodology: Cross-sectional assessment in Ghent University Hospital and Vienna Medical University. Participants filled in five questionnaires: the Decision Regret Scale (DRS), Penile Perception Score, Sexual Quality of Life Male, International Index of Erectile Function and a custom-made questionnaire. The DRS and custom-made questionnaires were also completed by the participants' parents. Urological examinations included: uroflow, postmictional and testicular ultrasound and genital examination. IBM SPSS© 25.0 was used to analyze the data: using a Pearson correlation, unpaired student t-test, Mann Whitney-U test or chi-square test, as appropriate.
Results: Results are presented in Table 1.
Conclusion: Very few patients regret having had HS surgery in childhood. Patients and physicians value outcome of HS surgery according to different criteria. We found a high rate of varicocele post HS surgery of unclear origin so far. Our data highlight the need for postpubertal revision of HS cases as long-term complications may occur that require surgical intervention at some times. In some cases, psychosexual counseling may be recommended.
Table 1. Summary of results
|Custom parents||Shocked by HS: at birth 95/150 (63,3%) - on the long-term: 19/150 (12,7%)|
Worries about testicular function: 71/150 (distal: 45,7%; prox: 51,1%)
|Custom participants||Regretted that their parents decided for them on having the HS repair: 3/153 (2,0%)|
Wished they never had the repair: 2/153 (1,3%)
Regret correlation with reintervention
|HS: ρ=0,222, P<0,001||Parents: ρ=0,291, P<0,001|
Dissatisfied about genital appearance
|HS: 13/153 (8,5%)||Controls: 1/42 (2,4%)|
Sexual dysfunction (< 50%)
|HS: 1/153 (0,7%)||Controls: none|
Erectile dysfunction (< 21)
|HS: 10/83 (12%)||Controls: 2/33 (6,1%)|
|Suboptimal esthetic outcome||Distal: 16/108 (14,8%)||Prox: 16/45 (35,5%)|
|Varicocele grade II or higher||HS: 31/153 HS (20,3%)||Controls: 2/42 (4,8%)|
HS: 34/149 (22,8%)
Distal: 21,9%; Prox: 25,0%
HS: 2/149 (1,3%)
Distal: 5/103 (4,9%)
Prox: 2/45 (4,4%)
|Testicular ultrasound||Microlithiasis (P=0,777)|
HS: 13/153 (8,5%)
Controls: 3/42 (7,1%)
Right: 12,3mL/12,7mL, P=0,547
Left: 11,9mL/12,1mL, P=0,740
Right: 9,5mL/12,6mL P=0,002
Left: 7,9mL/12,3mL P<0,001
19 - 21 Sep 2019
European Society for Paediatric Endocrinology