In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.

Purpose: We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, m e a d position and patient satisfaction.Materials and Methods: Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon.Results: There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery aRer our study.Conclusions: Hypospadias surgeons should explicitly ask if patients are satisfied and they should follow patients through adolescence.KEY WORDS: penis; hypospadias; surgery, plastic Corrective surgery of hypospadias, that is reconstructing the urethra and straightening the penis, is necessary to ensure voiding in the standing position and unhampered adult sexual functioning. Another important goal of hypospadias surgery is the achievement of a cosmetic penile appearance that is as normal as possible. Others who studied long-term results of hypospadias surgery reported patient satisfaction with the penile appearance or surgeon satisfaction with the surgical result.'-6 To our knowledge only Schwobel et a1 have previously assessed hypospadias patient and surgeon satisfaction with the cosmetic r e~u l t .~ Of the 27 patients 92% judged the cosmetic result to be satisfactory or excellent and all had a satisfactory or excellent cosmetic result, as judged by Schwobel et al. 7 Unfortunately, from these data it is impossible to determine the degree of agreement between patient and surgeon satisfaction, and only the position of the urethral meatus was considered in judgingthe surgical result. These previous studies made no distinction between satisfaction with functional result and cosmetic penile appearance. It was not known if hypospadias patients were satisfied with the same aspects of penile appearance as the surgeon. It seems essential to know whether hypospadias patients and surgeons consider the same aspects of penile appearance to be important to determine if patient treatment or counseling should be adjusted. Therefore, we evaluated in a standard manner the level of agreement between hypospadias patient and surgeon satisfaction with different asof patient penile appearance, and the relation between physid ChamCtenstics (penile length and meatal position) and satisfaction with penile appearance in hypospadias patients. PATlENTS AND METHODS Patients.Of the 458 patients treated for hypospadias between 1980 and 1992 at the Sophia Children's Hospital 113 who were 9 to 18 years old at the onset of our Study Previ2Z~oronal 703ously underwent terminal procedures, which split, core or tunnel through the glans to create a true t...

Plasma levels of testosterone and LH were estimated in female and male rats at gestational ages of 19, 20 and 21 days and at 1, 3, 6, 12, 18 and 24 h after birth. Concentrations of testosterone in the gonads were also estimated in 20-day-old fetuses and at various times after birth. Before birth female fetuses had significantly lower levels of testosterone and higher levels of testosterone and higher levels of LH than had male fetuses. During the first 24 h after birth female rats also had lower levels of testosterone and higher levels of LH than male rats. The pattern of levels of testosterone in the hours after birth was significantly different between female and male rats in that high levels were observed 1 and 3 h after birth in male rats (3.0 and 2.2 ng/ml respectively). This finding, as well as the relatively high levels of testosterone in female fetuses (about 50% of the levels found in male womb-mates) is discussed.

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