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Published on: January 7, 2019
Hypospadias: clinical approach, surgical technique and long-term outcome
Pier Luca Ceccarelli1, Laura Lucaccioni2, Francesca Poluzzi1
1Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
Insights
This study assessed long-term outcomes of hypospadias repair, finding high satisfaction with cosmetic results but varying functional outcomes. Standardized approaches are needed for better surgical repair and follow-up.
Area of Science:
- Pediatric Urology
- Congenital Abnormalities
- Surgical Outcomes
Background:
- Hypospadias is a common congenital abnormality in male newborns.
- Over 300 surgical procedures exist, with no universal approach.
- Short-term reoperation rates are common outcome measures but may not reflect long-term results.
Purpose of the Study:
- To evaluate long-term cosmetic, functional, and psychosexual outcomes after hypospadias surgical repair.
- To compare outcomes based on patient age, hypospadias severity, and respondent (child, parent, surgeon).
Main Methods:
- Retrospective review of medical records for 187 boys undergoing hypospadias repair.
- Assessment using clinical examination, life-related interviews, and validated questionnaires (PPS, HOSE, IIEF-5).
- Comparison of outcomes across different patient and procedural factors.
Main Results:
- 24.6% of patients experienced complications post-repair.
- High satisfaction with cosmetic results (83% children, 87% parents).
- Significant differences in functional outcomes (HOSE scores) based on hypospadias type, with children reporting lower scores than surgeons.
Conclusions:
- Long-term outcomes, particularly functional aspects, require careful consideration.
- A standardized approach to hypospadias repair and follow-up is recommended.
- Clinicians must be aware of long-term results to guide patient care and surgical techniques.
Background:
Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6-12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes.
Methods:
Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon).
Results:
187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5-22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child's age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child's HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents.
Conclusion:
Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.
