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...