Satisfaction with Penile Appearance after Hypospadias Surgery: The Patient and Surgeon View

Abstract

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...

Failed hypospadias in paediatric patients

“…In a study of 100 patients with proximal hypospadias and severe curvature, recurrent curvature was reported in a total of 22 patients, including three (of 32) children who underwent ventral lengthening procedures and 19 (of 68) who underwent dorsal plication (9% versus 28%; P = 0.03). 6 This study suggests that ventral lengthening could be more effective and durable in achieving penile straightening. However, in another study of 22 patients with recurrent curvature >10 years after initial penile straightening, 19 patients had received dorsal plication as their initial procedure and three had undergone ventral tunica vaginalis grafting.…”

“…The surgeon often has to rely on patient or parental report, which can vary significantly from surgeon assessment. 6 If physical examination during erection is unrealistic, photographs should be taken by the patient during erection. In any case, if the correction of residual or recurrent curvature is elected, an intraoperative erection test is mandatory before embarking on any further procedure.…”

“…For example, the prevalence of persistent curvature after hypospadias repair was significantly lower in patients for whom curva ture was assessed by the patient or a parent compared with the surgeon (presumably because these individuals do not give the same relevance to the same degree of curvature), 5 and adolescents with hypospadias seems to be generally less satisfied with the long-term results of a repair than the paediatric urologists who o perated on them as children. 6 The burden of a failed hypospadias repair can be devas tating for a patient and his family. In a series of 1,176 patients with failed hypospadias, a median of five additional procedures (ranging from 2-23) were required to achieve a satisfactory final result.…”

The Pediatric Penile Perception Score: An Instrument for Patient Self-Assessment and Surgeon Evaluation After Hypospadias Repair

“…However, with regard to the parents and the urologist's evaluation, it seems to be unlikely that this is the sole reason and other causes must be considered. Mureau has published an extensive survey on patient's satisfaction after hypospadias repair with a similar study design and found that his patients were less satisfied with the penile appearance than the treating surgeons 5 . In that questionnaire, 3 out of 8 items were related to penile size and one to the appearance of the scrotum and testes, so that comparison to our results is difficult.…”

Preputial reconstruction in hypospadias repair

“…Long-term studies have shown that the absence of the prepuce is one of the features that remind patients of the surgery they underwent as children [28]. Örtqvist et al [29] have reported that one-third of Swedish adults who had undergone HR in combination with circumcision in childhood declared they wished they had the foreskin intact.…”