The psychosexual aspects of hypospadias repair: A review

Deibert, Christopher M.; Hensle, Terry W.

doi:10.1016/j.aju.2011.10.004

Cited by 13 publications

(7 citation statements)

References 24 publications

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“…Currently, no standardized questionnaires are available for the evaluation of psychosexual function after hypospadias repair [ 17 ]. Functional outcome is mainly assessed by uroflowmetry and postvoid residual measurements (Fig.…”

Section: Long-term Outcomesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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Hypospadias is one of the most common congenital anomalies in men. The condition is typically characterized by proximal displacement of the urethral opening, penile curvature, and a ventrally deficient hooded foreskin. In about 70%, the urethral meatus is located distally on the penile shaft; this is considered a mild form that is not associated with other urogenital deformities. The remaining 30% are proximal and often more complex. In these cases, endocrinological evaluation is advised to exclude disorders of sexual differentiation, especially in case of concomitant unilateral or bilateral undescended testis. Although the etiology of hypospadias is largely unknown, many hypotheses exist about genetic predisposition and hormonal influences. The goal of hypospadias repair is to achieve cosmetic and functional normality, and currently, surgery is recommended between 6 and 18 months of age. Hypospadias can be corrected at any age with comparable complication risk, functional, and cosmetic outcome; however, the optimal age of repair remains conclusive. Although long-term overall outcome concerning cosmetic appearance and sexual function is fairly good, after correction, men may more often be inhibited in seeking sexual contact. Moreover, lower urinary tract symptoms occur twice as often in patients undergoing hypospadias repair and can still occur many years after the initial repair. Conclusion: This study explores the most recent insights into the management of hypospadias. What is Known: • Guidelines advise referral for treatment between 6 and 18 months of age.• Cosmetic outcome is considered satisfactory in over 70% of all patients. What is New: • Long-term complications include urinary tract symptoms and sexual and cosmetic issues.• New developments allow a more individualized approach, hopefully leading to less complications and more patient satisfaction.

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Section: Long-term Outcomesmentioning

confidence: 99%

Hypospadias, all there is to know

2017

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“…In particular, 10 of the 49 studies included gave no length of follow-up, 14 reported a follow-up of less Undoubtedly, the greatest weakness of our study is the need for a two-stage repair for anatomically complex cases with adverse urethral characteristics. Apart from the risk of a second general anesthesia, two-stage repairs are associated with substantial inconvenience for the patients and their caregivers and can have an important negative psychological impact on the boys, which can be carried with them later on in adult life (27). However, it is our opinion, that a possibly reduced complication risk for anatomically complex cases is fair justification for a twostage repair.…”

Section: Discussionmentioning

confidence: 92%

Urethral Plate Characteristics in Cases of Non-proximal Hypospadias May Not Be Associated With a Higher Risk of Complications When a Two-Stage Repair Is Applied

et al. 2022

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PurposeTo investigate whether a two-stage repair of distal- and mid-shaft hypospadias (non-proximal hypospadias) could eliminate the risk factors resulting from adverse urethral plate characteristics and eventually reduce complication rates.MethodsWe retrospectively reviewed all cases of primary surgical repair of non-proximal hypospadias performed in our center between 2009 and 2018. In all cases where adverse urethral plate characteristics were found, such as meatal stenosis, a shallow urethral groove, a thick web of tissue between the native meatus and the urethral groove or in the presence of a very “thin,” skin-like distal urethra, a two-stage repair was routinely undertaken. In cases of native meatal stenosis, a meatotomy, and meatoplasty were performed. In cases of a very “thin” distal urethra we incised the skin proximally up to the point of a normal urethral fold and a meatoplasty was performed at that point. Hypospadias repair was then performed in a second operation, 3–6 months following the first procedure. Urethroplasty, both in cases of a single-stage repair and in cases of a two-stage repair, was always performed using the Thiersch-Duplay technique. Patients with a follow-up of less than 12 months were excluded from this study.ResultsOver a period of 10 years, 208 boys underwent primary surgical repair of non-proximal hypospadias. Eighty-nine of the 208 patients (42.8%) underwent single-stage hypospadias repair. Two-stage repair of the hypospadias was required in 119 (57.2%) of the patients. The overall complication rate was 3.4% in the group operated in a single stage and 7.6% in the group that required a two-stage repair (p = 0.09). The most frequent complication reported was urethrocutaneous fistula (p = 0.31), followed by meatal stenosis (p = 0.37), urethral stricture (p = 0.08) and wound dehiscence (p = 0.16). There was no significant difference between the complication rates of the two groups.ConclusionPatients with distal hypospadias and poor urethral plate characteristics repaired in a two-stage approach have comparable low-complications to those with favorable urethral plate characteristics repaired in a single-stage.

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“…Moreover, the literature on the outcomes of pediatric hypospadias repair has established excellent short-term results, but the majority of hypospadias studies lack follow-up into adulthood and do not discuss the psychosexual aspect of hypospadias repair. For children and adolescents, the Child Behavior Checklist has been used, while in adults, the Minnesota Multiphasic Perception Inventory is often used to evaluate psychological questions [14]. The Pediatric Penile Perception Score (PPPS) is an instrument developed for the assessment and comparison of penile appearance.…”

Section: Discussionmentioning

confidence: 99%

Accessory penis: A rare method of peno-urethral separation of sexual function and voiding following successful complex hypospadias reconstruction with a free ileum flap

2019

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Hypospadias is a congenital malformation of the male genitalia. The reconstructive objectives are to obtain voiding with laminar flow and satisfactory sexual function. Several urethroplasty techniques have been described, but for perineal or revisional cases no single technique has shown robust success. In this study, we describe the expanded use of intestinal flaps for urethral reconstruction and report a peculiar request from a patient to undergo peno-urethral separation after successful hypospadias repair with a free ileum flap. A 51-year-old male patient with perineal hypospadias underwent several urethral reconstructive procedures with poor outcomes. A free ileum flap was attempted as a substitute for the urethra. Following successful reconstruction, separation of the neo-urethra (ileum) from the penile body was performed to address the patient’s sexual expectations. A free ileum flap proved to be a reliable urethral substitute in perineal hypospadias reconstruction, with a successful outcome. The peno-urethral separation with the creation of an “accessory penis,” however peculiar, optimized the results in terms of both sexual and urinary function. Anatomical restoration of the urethra and patient-reported expectations are the key to successful hypospadias reconstructive procedures. Sexual function outcomes and the patient’s perception of success should not be underestimated, even when urinary function has been restored.

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The psychosexual aspects of hypospadias repair: A review

Cited by 13 publications

References 24 publications

Hypospadias, all there is to know

Hypospadias, all there is to know

Urethral Plate Characteristics in Cases of Non-proximal Hypospadias May Not Be Associated With a Higher Risk of Complications When a Two-Stage Repair Is Applied

Accessory penis: A rare method of peno-urethral separation of sexual function and voiding following successful complex hypospadias reconstruction with a free ileum flap

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