Long-term urinary, sexual and cosmetic outcomes in hypospadias repair

Abstract

Hypospadias is a congenital defect of the penis, which occurs in one out of 200-300 newborn boys. The meatus of the urethra is not positioned at the top of the glans, but somewhere between the glans and the scrotum. Surgical correction of hypospadias is performed around their first birthday, sometimes combined with a correction of a penile curvature. The goals of treatment are a forward, straight urinary stream, a straight penis in erection and a normal penile appearance. However, puberty can cause complications due to penile growth and sexual interest is increasing during this phase. Therefore, the final outcomes of surgical corrections can only be assessed after puberty. In this thesis boys with hypospadias, operated between 1987-1993, were evaluated at the age of 18 years old to assess their long-term micturition, sexual and cosmetic outcomes in hypospadias. In general, hypospadias patients had satisfying outcomes, but more severe hypospadias - those with ameatus near the scrotum at first - have a higher chance of complications, sexual outcomes and cosmetic outcomes. Subanalysis of the group was done, revealing no negative outcomes of preoperative stimulation of the penis with testosterone, the foreskin could be preserved in mild hypospadias patients and severe hypospadias patiënt can be treated with a single-stage surgical technique (Duckett tube) with fairly good results.