Long-term follow-up study of patients with hypospadias focusing on their sex life

BACKGROUND: Hypospadias is a well-known congenital malformation (approximately 18.6 new cases reported per 10 000 male newborns); however, little is known about the long-term effects of corrective surgery on patients' sex life in adulthood. AIM: Our aim was to identify how surgical outcomes contribute to patients' and partners' satisfaction with the operated penis and to the ability to have a satisfying sex life and father children, and to better understand which aspects of corrective surgery are the most important. METHODS: We analyzed the clinical data of 501 adult patients who were operated at our department (Department of Pediatric Urology, Heim Pál Children's Hospital, Budapest, Hungary) as children with hypospadias. We designed a Google Forms questionnaire containing simple questions about partnership, penile appearance and function, and patient satisfaction for them and their partners. To assess complex psychological constructs, validated questionnaires were used. We measured relationship satisfaction (the Hungarian version of the Relationship Assessment Scale), sexual distress (Short version of the Sexual Distress Scale), sexual dysfunction (Arizona Sexual Experience Scale), sexual desire (Sexual Desire Inventory), and sexual satisfaction (Global Measure of Sexual Satisfaction). OUTCOMES: Out of the 414 patients who we could reach out to, 78 patients with mean (±SD) age of 24.38 ± 5.21 years, and 12 partners filled out the forms. RESULTS: The patients' overall satisfaction with their penis was generally good and this was mostly related to satisfaction with its appearance (r = .60). The location of the meatus was not related to either patient satisfaction or the capacity of having a child. The straightness of the penis, the number and type of penile corrective surgeries, or age at the first operation did not affect patient satisfaction. Partners were mostly content with the corrected penis, and their satisfaction depended on a subjective liking. CLINICAL IMPLICATIONS: We have found that it is not necessary to achieve a completely straight penis or to extend the neourethra to the tip of the glans, nor is a one-stage surgery required for patient satisfaction. STRENGTHS & LIMITATIONS: The most significant strength of our study is its comprehensive methodological design and the use of validated questionnaires to measure psychological constructs. Its biggest limitation is the low number of participating partners. CONCLUSION: Our data show that subjective satisfaction with penile appearance is associated with higher overall satisfaction more strongly than urinary function in young adults operated for hypospadias in their childhood and also that of their partners so these observations need to be taken into account when deciding surgical strategy.