As urologists, it is important to know our results. In terms of hypospadias surgery, which is commonly undertaken after the age of one year in the UK, long-term follow-up is required to fully acquire this knowledge. Long-term urinary outcomes and sexual function are under evaluated / reported.
During surgery, we aim to achieve a glanular meatus to allow voiding in a standing position and straighten the penis sufficiently to allow subsequent adequate sexual / reproductive function. Here, Tack et al. have utilised a cross-sectional study to assess the long-term surgical, functional urinary and sexual outcomes of adolescent and young men who underwent childhood hypospadias repair at two centres (Ghent University Hospital and Medical University of Vienna). Results have been compared to a group of healthy male peers; they hypothesised that outcomes are often suboptimal and associated with the severity of the defect, age at first surgery, reinterventions and adult penile size. Participation rate was 48.5%; 176 patients had primary hypospadias surgery between September 1997 and February 2010. 39.2% of cases underwent one or more reintervention procedures (this was sometimes performed one to two decades after the initial surgery). Smaller adult stretched penile length (SPL), surgery before one year of age and proximal hypospadias were associated with more reinterventions. More distal and mid shaft cases had at least one intervention if the primary repair was undertaken before the age of one year. Proximal hypospadias had more reinterventions for fistulas and residual hypospadias and less for aesthetic reasons. Suboptimal voiding (using a flow index) was noted in 22.1% of hypospadias cases. Sexual function problems were reported in 20.3% of cases vs. 6.0% of controls. Curvature of the penis greater than 30 degrees was rare in follow-up in distal hypospadias (2.3%) compared to mid shaft (10.5%) or proximal hypospadias (21.7%). The authors recommend avoidance of surgery before the age of one year and that follow-up should be undertaken into adulthood. This manuscript is well worth a read for both the paediatric and adult urologist. Obviously, a variety of techniques may have been utilised, some of which may have less relevance today. The study backs up my opinion that long-term follow-up is required to gain a full perspective of one’s own hypospadias outcomes, and it is only something that I will appreciate fully with the course of time.
