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

Lloyd Tack; Hoecke Eline Van; Alexander Springer; Stefan Riedl; Ursula Tonnhofer; Julia Weninger; Manuela Hiess; Laecke Erik Van; Piet Hoebeke; Anne-Françoise Spinoit; Martine Cools

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 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%)
DRS Regret correlation with reintervention	HS: ρ=0,222, P<0,001		Parents: 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 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%)
Abnormal uroflow	Plateau 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 ultrasound	Microlithiasis (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

ESPE Abstracts

P1-261