Bulbospongiosus Muscle Reconstruction in Proximal Hypospadias: Post Pubertal Function and Patient Satisfaction.

Area of Science:

• Urology
• Pediatric Surgery
• Andrology

Background:

• Ejaculatory disturbances are common after proximal hypospadias repair in puberty.
• The bulbospongiosus muscle (BSM) is crucial for normal ejaculation and erections.
• Assessing adolescent outcomes after BSM reconstruction in proximal hypospadias is important.

Purpose of the Study:

• To evaluate adolescent functional and aesthetic outcomes following proximal hypospadias repair with bulbospongiosus muscle reconstruction.
• To determine the impact of BSM repair on urinary stream, ejaculation, and patient-reported satisfaction.

Main Methods:

• Defined proximal hypospadias and severe ventral curvature (>30°).
• Performed bulbospongiosus muscle apposition around the bulbar urethra in a 2-stage surgery.
• Conducted annual post-pubertal assessments including Hypospadias Objective Scoring Evaluation (HOSE) and patient-reported Penile Perception Score (PPS), urination, and ejaculation descriptions.

Main Results:

• 22 patients completed pubertal assessments, with a mean follow-up age of 17.2 years.
• 95.4% reported strong urinary streams, and 94.4% described ejectile ejaculations.
• Median HOSE score was 14p and PPS was 16p, indicating good functional and aesthetic results.

Conclusions:

• Reconstruction of the bulbospongiosus muscle in proximal hypospadias repair results in satisfactory urinary and ejaculatory function in adolescents.
• Patients reported high satisfaction with genital function and aesthetics, irrespective of meatal position.
• The study supports BSM reconstruction as a key element in achieving positive outcomes for proximal hypospadias.