S.P. Rynja

Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood

OBJECTIVE Long-term results of hypospadias repair are scarce. Previous reviews mostly described mid-term results making extrapolation to long-term results difficult. This systematic review on long-term results in postpubertal men after hypospadias repair in childhood, aims to inform urologists and parents of a newborn boy with hypospadias about future expectations. METHODS AND MATERIALS The Pubmed/Medline and Embase databases were searched until February 2010. Inclusion criteria stated that patients with hypospadias were operated before the age of 6 years and were older than 14 years at follow up. Results were pooled and analyzed using SPSS 16.0. Data on proximal hypospadias patients and controls are described separately. RESULTS Twenty eligible studies investigating micturition, cosmesis and psychosexual functioning were found. Hypospadias patients report more urinary symptoms and have a lower Qmax than controls. Patients are less satisfied with penile appearance compared to controls. Objectively assessed cosmetic results are good. Sexually, patients are as active as controls, but are less satisfied. Patients less often have an intimate relationships compared to controls. CONCLUSION Study outcomes were heterogeneous due to operation techniques and a lack of validated questionnaires and control groups. Long-term results of hypospadias patients should be measured in a prospective design using validated measurement tools.

Long-Term Followup of Hypospadias: Functional and Cosmetic Results

PURPOSE We assessed long-term results after hypospadias surgery with respect to urinary and sexual function, cosmetic appearance and intimate relationships. MATERIALS AND METHODS We contacted 116 patients who are now adults and who underwent surgery between 1987 and 1992. Participation included mailed questionnaires containing the International Prostate Symptom Score, International Index of Erectile Function and the Dutch Survey of Intimate Relations (Nederlandse Relatie Vragenlijst) as well as uroflowmetry and cosmesis assessment using the Pediatric Penile Perception Score. A control group of 151 male students completed the International Prostate Symptom Score and International Index of Erectile Function, and underwent uroflowmetry. RESULTS A total of 91 patients (78%) were traceable, 57% returned the questionnaires and 27% visited the clinic. Hypospadias was distal, mid shaft and proximal in 47, 8 and 11 patients, respectively. International Prostate Symptom Score was greater than 7 in 9 of 64 patients (14%) compared to 10 of 151 controls (7%). Patients with distal hypospadias complained more about micturition. Patients with proximal hypospadias had lower maximum urine flow than other patients and controls. For sexuality the total International Index of Erectile Function did not differ between patients and controls. Patients with proximal hypospadias reported less satisfaction with penile length and objectively penile length was less than the average of all patients (10.8 vs 12.1 cm). Cosmetic outcome was considered satisfactory. Outcomes in the 33 patients who returned the Dutch Survey of Intimate Relations correctly were above average, especially for sexuality and independence. CONCLUSIONS Patients with distal hypospadias have a higher International Prostate Symptom Score and patients with proximal hypospadias have lower maximum urine flow than controls. Sexual function and cosmesis are rated good. The quality of intimate relationships is above average.

Long-term Follow-up After Transurethral Treatment of Infravesical Obstruction in Boys

OBJECTIVE To study whether boys who underwent transurethral treatment of (mild) infravesical obstruction during childhood have lower urinary tract symptoms and complications at young adult age. MATERIALS AND METHODS Young adult men who underwent transurethral treatment for infravesical obstruction as a child were contacted. The following measurements were done: International Prostate Symptom Score (IPSS), International Consultation on Incontinence Modular Questionnaire on Urinary Incontinence, frequency volume chart uroflowmetry, and postvoid residual. A group of 151 male students who completed IPSS and underwent uroflowmetry was used as reference group to compare with patients. RESULTS Of 135 traceable patients, 87 men (median age 21.9 years; interquartile range [IQR] 19.6-25.6) returned the questionnaires, and 71 underwent uroflowmetry. Median age at initial treatment was 7.9 years (IQR 1.0-10.8). Compared with men in the reference group, patients had similar IPSS and quality of life scores; median IPSS was 3, and IPSS-quality of life 1 (IQR 0.0-1.0). Urgency incontinence and postmicturition incontinence were reported in 2.4% and 8.5%, respectively. Frequency volume charts (n = 29) showed normal frequency and voided volumes. Uroflowmetry results were comparable with the reference group, although 16 (22.5%) patients voided volumes >600 mL. One patient had urethral stricturing, and one a significant postvoid residual. CONCLUSION Young adult men treated for (mild) urethral obstruction in childhood have few micturition symptoms and good uroflowmetry results, not different from a reference group. Some patients, however, report incontinence, and this group deserves close attention. Late complications were rare.

19 Seksuele functie bij jongvolwassen mannen na hypospadiecorrectie; evaluatie aan de hand van de Golombok Rust Inventory of Sexual Satisfaction

SamenvattingHet doel van hypospadiecorrecties is een voorwaarts gerichte urinestraal, een rechte erectie en een normaal cosmetisch uiterlijk te bewerkstelligen.

715 LONG-TERM FOLLOW UP INTO ADULTHOOD OF BOYS OPERATED FOR HYPOSPADIAS: A STUDY INTO FUNCTIONAL AND COSMETIC RESULTS

Study design, materials and methods Between January 1987 and January 1992, 116 patients, now adults, were operated for hypospadias in our institution. Ninety-one of them could be traced and were included in this study. Patients were asked to complete questionnaires on the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), the Nederlandse Relatie Vragenlijst (NRV, Dutch Relationship Survey) as well as additional questions. Cosmetic results were assessed using the Hypospadias Objective Penile Evaluation (HOPE) score and uroflowmetry with post void residual measurement by ultrasound was performed. As a control group, 151 male medical students filled out the questionnaire (IPPS and IIEF) and underwent uroflowmetry. Acquired data was analyzed using SPSS 12.0. Data analysis was done by Students’ T-test, Chi-square test, ANOVA, Pearson’s and Spearman’s rank correlation with a p-value <0.05 considered significant.