Our Summary

This research paper explores the long-term effects of surgeries done to correct hypospadias (a condition where the opening of the urethra is on the underside of the penis, rather than at the tip) in young boys. The study included men aged 16-21 who had the surgery when they were children, and compared them to a control group of healthy men.

The researchers found that about 39% of the men who had the surgery needed at least one more operation afterwards. The rate of needing additional surgeries was highest among those who had the initial surgery when they were less than a year old. This remained true even when they excluded cases where the hypospadias was more severe (where the opening was closer to the base of the penis).

The study also found that about 53% of the men who had the surgery had issues with urination or sexual function. About 22% had problems with urination, although most did not have significant leftover urine after urinating.

The researchers found that having more surgeries and having more severe hypospadias were associated with worse urinary outcomes. More severe hypospadias was also linked to worse sexual function.

The study also showed that doctors and patients often had different opinions about the aesthetic outcome of the surgery.

The researchers concluded that in about 53% of cases, there were issues that needed ongoing attention and follow-up. They also suggested that doctors should be more cautious about doing additional surgeries to improve the appearance of the penis, unless the patient specifically asks for it, as this could potentially improve urinary outcomes.

FAQs

  1. What is considered a good outcome in a hypospadias repair?
  2. What factors are associated with suboptimal outcomes in hypospadias repair?
  3. How frequent are reinterventions in hypospadias repair, and are they more common in certain age groups?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about hypospadias repair is to ensure long-term follow-up and monitoring of surgical, urinary, and sexual outcomes. It is important to address any concerns or issues that may arise over time, as up to 52.9% of cases may require ongoing management. Additionally, considering a conservative approach to aesthetic refinement, unless specifically requested by the patient, may help improve urinary outcomes.

Suitable For

Patients with nonsyndromic hypospadias who underwent childhood hypospadias repair are typically recommended for follow-up and potential reinterventions if needed. Patients who underwent hypospadias repair below 12 months of age may have a higher risk of needing reinterventions. It is important to assess long-term surgical, functional urinary, and sexual outcomes in adolescent and young adult men who have undergone hypospadias repair to ensure optimal outcomes. A restrictive attitude towards aesthetic refinement, unless requested by the patient, may improve urinary outcomes in these patients.

Timeline

Before hypospadias repair:

  • Patient is born with nonsyndromic hypospadias
  • Surgical repair is typically performed during infancy or early childhood
  • Patient may undergo multiple surgeries or interventions before reaching adolescence

After hypospadias repair:

  • Patient is assessed for long-term surgical, urinary, sexual, and aesthetic outcomes during adolescence and young adulthood
  • Reinterventions may be necessary in some cases, with a higher rate seen in those who underwent repair before 12 months of age
  • Suboptimal urinary and sexual functional outcomes are identified in over half of cases
  • Aesthetic concerns may not align between physicians and patients
  • Long-term follow-up is recommended for at least 52.9% of cases to address any identified concerns.

What to Ask Your Doctor

  1. What is the success rate of the hypospadias repair surgery in terms of achieving a patent and orthotopic meatus without fistulas?
  2. How common is it to require reintervention after the initial hypospadias repair surgery?
  3. What factors may increase the likelihood of needing reintervention after hypospadias repair?
  4. What potential urinary and sexual functional outcomes should I expect following hypospadias repair surgery?
  5. How often should I follow up with my doctor after the initial hypospadias repair surgery?
  6. Are there any lifestyle changes or precautions I should take to optimize the long-term outcomes of the hypospadias repair surgery?
  7. Is there a risk of developing complications such as erectile or ejaculatory problems after hypospadias repair surgery?
  8. Can you provide me with resources or support groups for individuals who have undergone hypospadias repair surgery?
  9. Are there any specific concerns or considerations for adolescent and young adult men who underwent childhood hypospadias repair surgery?
  10. How should I discuss and address any aesthetic concerns or requests for further refinement of the surgical outcome?

Reference

Authors: Tack LJW, Springer A, Riedl S, Tonnhofer U, Hiess M, Weninger J, Mahmoud A, Van Laecke E, Hoebeke P, Cools M, Spinoit AF. Journal: J Urol. 2021 Sep;206(3):734-744. doi: 10.1097/JU.0000000000001869. Epub 2021 May 6. PMID: 33955779