Long-term perspectives on hypospadias

Abstract: Hypospadias, a multifactorial condition and one of the most common congenital malformations, has an incidence of 1/125 boys born. The infants are born with an ectopic meatus placed ventrally on the penis varying from a glanular to a perineal position, a cleaved prepuce, and often a penile curvature. The treatment is surgical and aims to achieve a satisfactory cosmetic result, an ability to void normally, and to have satisfactory sexual functions. The aim of this thesis was to evaluate the long-term outcome of men born with hypospadias. All the studies were based on a questionnaire sent to 167 patients and 169 age-matched controls, as well as 47 circumcised controls operated for phimosis. A subgroup of patients and controls came for a clinical exam, which included uroflowmetry and a psychiatric screening. Study I, investigating the urological outcome and cosmetic result after surgery, revealed that patients had more voiding dysfunction and a lower maximal urinary flow rate. They also had a shorter penile length and were less satisfied with the cosmetic appearance than controls. Patients with proximal hypospadias had a shorter penile length and were less satisfied than the other patients. Study II, focusing on the psychosocial long-term outcome, revealed that patients with hypospadias have a comparable psychosocial situation to controls and a good quality of life. Patients with proximal hypospadias had a history of more medical follow-up and psychological support than patients with more distal hypospadias and also expressed a need for more psychological support in the future. The aim of Study III was to investigate the fertility and psychosexual function. A comparable fertility and a favourable psychosexual function were revealed, with 80% of both patients and controls expressing satisfaction with their sexual life. Patients with proximal hypospadias had a lower reported fertility compared with controls and with patients with more distal hypospadias. Proximal hypospadias decreased the odds of a man being satisfied with his sexual life. Study IV assessed the prevalence of psychiatric symptoms of ADHD, affective disorders and other common psychiatric diagnoses. The results did not identify an increased psychiatric morbidity in men with hypospadias. In conclusion, the long-term outcome in men born with hypospadias is, in general, good. However, genital appraisal is impaired in all groups with a risk of causing both psychosocial and psychosexual impairment. Patients with proximal hypospadias need more follow-up and support, and transitional care is important.