| ObjectiveThe aim of this study was to assess the long-term outcome of hypospadias surgery performed in childhood and analyze the relative factors which can affect the situation.MethodsA detailed questionnaire was applied to 174 patients who were operated for hypospadias and completed their treatment at Shandong Provincial Hospital(Jinan, China) between 1984 and 1992 by mail,phone call and interview.Each of them was older than 18 years at the time of this survey.Correlation analysis was performed to find the relations between the accepted data and the chief affecting factors.ResultsOf 43 patients,26 had distal,17 had proximal hypospadias.The mean ages of patients at the first operation and at the time hypospadias repair was completed were 5.7 years(range,1.7-12.3 years) and 7.4 years(range,3.2-20.8 years),respectively. The mean operation times were 1.9(range,1-5).The mean age of these participants at the time they filled the questionnaire was 21.6 years(range,18.1-34.2 years).19 patients had one or more kinds of complications at the first operation.Forty-three participants finished the questionnaire.Regarding the overall evaluation of penile appearance,7 patients(16.3%) were "completely satisfied" and 13 patients (30.2%) were "generally satisfied".However,23 patients(53.5%) were "dissatisfied" with penile appearance.The main reason for dissatisfaction was smaller penile size and obvious curvature.Of the 43 respondents,41.9%had micturition troubles.These patients often complained of spraying,wrong direction of urinary stream,and after-dribbling. Regarding the overall evaluation of urinary function,23 patients(53.5%) were "completely satisfied",16 patients(37.2%) were "generally satisfied",4 patients (9.3%) were "dissatisfied".Regarding the overall evaluation of sexual function,19 patients(44.2%) were "completely satisfied",17 patients(39.5%) were "generally satisfied",and 7 patients (16.3%) were "dissatisfied".When Sexual functioning was concerned,90.7%of patients reported normal strength of libido.And 76.7%(33/43) of participants reported self-rated quality of erection as "very good" to "good".Of the participants, 23.3%(10/43) reported the existence of problems during erection,who reported quality of erection as "fair" to "poor".The main complaint was smaller penile size and increased obvious curvature during erection.Each of these 43 participants had experienced ejaculation by sexual intercourse or masturbation.Among them,there were 17 patients(39.5%) with problems during ejaculation.The main complaint was impotent ejaculation.Eighteen(41.9%) of these participants had experienced sexual intercourse before this survey.Of them,88.9%(16/18) reported no problems with sexual intercourse.Twenty-eight patients(65.1%) complained the psychological inhibition due to their penis problems.A negative correlation was found between the satisfaction with penile appearance(p＜0.05),extent of hypospadias knowledge(p＜0.05) and the level of psychological and sexual inhibition.Regarding the overall evaluation of the result of operations,13 patients(30.2%) were "completely satisfied",19 patients(44.2%) were "generally satisfied",and 11 patients(25.6%) were "dissatisfied".Of these patients,88.4%were willing to know more about hypospadias and 74.4%wished they had longer follow-up.Regarding severity of hypospadias,patients with proximal hypospadias were more dissatisfied with penile appearance than those with distal hypospadias(P＜0.025).And they complained problems more frequently during micturition(P＜0.01),erection (P＜0.05),ejaculation(P=0.00),and sexual intercourse(P＜0.05),and were more psychologically inhibitive(P＜0.025) and more sexually passive(P＜0.05),compared to those with distal hypospadias.Regarding occurrence of complications,patients with complications were more dissatisfied with penile appearance than those without complications(P＜0.025).And they complained problems more frequently during micturition,erection(P＜0.025), ejaculation(P＜0.01),and sexual intercourse,and were more psychologically inhibitive (P＜0.01) and more sexually passive(P＜0.025),compared to those without complications.Furthermore,negative correlations with statistical significance were found between age at the first operation and self-rated scale of satisfaction with sexual function(r= -0.331,P＜0.05),age at the final operation and self-rated scale of satisfaction with urinary function(r= -0.307,P＜0.05),age at the final operation and the level of psychological and sexual inhibition(r= -0.313,P＜0.05),number of operations and self-rated scale of satisfaction with penile appearance(r= -0.317,P＜0.05).There are positive correlations with statistical significance between self-evaluated scale of satisfaction with penile appearance(r= 0.363,P＜0.025),sexual function and satisfaction with the gross result of operations(r= 0.325,P＜0.05),respectively.Furthermore,according to the different opinion on penile appearance to analyze, these patients who were dissatisfied with penile appearance complained problems more frequently during micturition(P＜0.05),erection(P＜0.025),ejaculation(P＜0.025) and sexual intercourse,and were more sexually passive(P＜0.05),compared to those who were satisfied.There are positive correlations with statistical significance between self-evaluated scale of urinary function(r= 0.321,P＜0.05),sexual function and satisfaction with penile appearance(r= 0.469,P＜0.01),respectively.Conclusions1.Although patients are possible to encounter some problems in urinary,sexual or psychological aspects in adulthood,but majority have the good long-term results after hypospadias surgery.2.Patients who were operated for hypospadias had a significantly careful concern about penile appearance.Rate of dissatisfaction with penile appearance were slightly high in patients after hypospadias surgery.Penile size had a significant impact on satisfaction with penile appearance.The better cosmetic outcome is related with the better long-term outcome after hypospadias surgery.3.The severity of hypospadias,occurrence of complications,age at which surgery was performed had relations to the long-term results of hypospadias surgery.To clarify the optimal timing of hypospadias surgery and reduce early complications are helpful in improving satisfaction with the long-term results.
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