Long-term patient reported outcomes after childhood hypospadias repair: a multicentre cohort study

Hypospadias is a common congenital malformation of the genitourinary tract that can lead to lasting functional, cosmetic, and psychosocial consequences.

To evaluate long-term patient-reported outcomes, postoperative complications, and overall satisfaction in individuals who underwent primary hypospadias repair in childhood.

Following institutional approval, all patients who had undergone initial hypospadias repair at two Italian centres between 1979 and 2015 and were over 16 years of age were contacted by telephone. Consenting individuals (n = 163) completed validated questionnaires, and clinical records provided data on hypospadias type (distal vs. proximal) and reinterventions. Scores were analysed by domain and compared according to hypospadias severity and reoperation status (P < 0.05 deemed significant).

At a median follow-up age of 24 years (interquartile range [IQR] 20-29), 79.8% of cases were distal (n = 130) and 20.2% proximal (n = 33); 31.3% (n = 51) had undergone reoperation. Overall outcomes were favourable: median hypospadias objective scoring evaluation (HOSE) 14.0 (IQR 11-15), median penile perception score (PPS) 9.0 (IQR 8-10), and median hypospadias objective questionnaire (HOQ) satisfaction 14.0 (IQR 11-16), and median total satisfaction in genital hypospadias treatment (SIGHT) 29.0 (IQR 24-34). A total of 51.6% were sexually active, with a median SIGHT sexual-function item score of 4.0 (IQR 3-5). Urethrocutaneous fistula occurred in 26.4%. Proximal cases had higher re-operation rates (51.5% vs 26.1%) and worse aesthetic (PPS median 8.0 vs 10.0), functional (HOSE median 13.0 vs 14.0), and psychosocial (SIGHT median 26.0 vs 30.0) scores than distal cases. Patients requiring re-intervention maintained satisfactory median HOSE (14.0) and SIGHT (29.0) scores. Follow-up preference, surgery recall, and centre loyalty medians were 3.0 (IQR 3-4), 2.0 (IQR 1-2), and 2.0 (IQR 2-2), respectively.

Validated patient-reported and clinical questionnaires assessing cosmetic (PPS, HOQ), objective/functional (HOSE, HOQ), and psychosexual outcomes (SIGHT).

Strengths include the use of validated patient-reported measures and a multicentre, post-pubertal cohort. Limitations include the retrospective design, potential responder and self-reporting bias, lack of a control group, and heterogeneity introduced by combining different validated instruments.

Adolescent patients who underwent hypospadias repair reported satisfaction with cosmetic, urinary, and sexual outcomes comparable to previous studies. However, variations in satisfaction and persistent psychological concerns following complications underline the importance of recognizing patients' subjective experiences. Multidisciplinary, long-term follow-up and tailored psychosocial support are essential to optimize psychosexual adjustment and quality of life after surgery.