ESPE Abstracts (2019) 92 P1-261

Long-Term Urological and Psychosexual Outcome of Men Born with Hypospadias

Lloyd Tack1, Eline Van Hoecke1, Alexander Springer2, Stefan Riedl2, Ursula Tonnhofer2, Julia Weninger2, Manuela Hiess2, Erik Van Laecke1, Piet Hoebeke1, Anne-Françoise Spinoit1, Martine Cools1


1Ghent University Hospital, Ghent, Belgium. 2Vienna Medical University, Vienna, Austria


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

1. Questionnaires
Custom parentsShocked 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 participantsRegretted 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%)
DRS
Regret correlation with reintervention
HS: ρ=0,222, P<0,001Parents: ρ=0,291, P<0,001
PPS
Dissatisfied about genital appearance
HS: 13/153 (8,5%)Controls: 1/42 (2,4%)
SQoL-M
Sexual dysfunction (< 50%)
HS: 1/153 (0,7%)Controls: none
IIEF-5
Erectile dysfunction (< 21)
HS: 10/83 (12%)Controls: 2/33 (6,1%)
2. Urological
Suboptimal esthetic outcomeDistal: 16/108 (14,8%)Prox: 16/45 (35,5%)
Varicocele grade II or higherHS: 31/153 HS (20,3%)Controls: 2/42 (4,8%)
Abnormal uroflowPlateau
HS: 34/149 (22,8%)
Distal: 21,9%; Prox: 25,0%
Staccato
HS: 2/149 (1,3%)
Residue
Distal: 5/103 (4,9%)
Prox: 2/45 (4,4%)
Testicular ultrasoundMicrolithiasis (P=0,777)
HS: 13/153 (8,5%)
Controls: 3/42 (7,1%)
Mean volume
HS/controls
Right: 12,3mL/12,7mL, P=0,547
Left: 11,9mL/12,1mL, P=0,740
Mean volume
Complex/isolated HS
Right: 9,5mL/12,6mL P=0,002
Left: 7,9mL/12,3mL P<0,001