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INTRODUCTION: Distal hypospadias is often operated in early childhood on the assumption that adjusting penile appearance reduces disturbances in psychological development. However, data on the outcome of unoperated men is scarce, and therefore, this assumption has no evidence base. This study compares the psychological outcome of men with uncorrected distal hypospadias to age-matched men without a genital variation. METHODS: In a cross-sectional study, 39 men with uncorrected distal hypospadias (age range: 20-70 years; mean age: 49.05 years, SD: 13.34) and a control group of 39 age-matched, unaffected men (age-range: 20-70 years; mean age: 49.08 years, SD: 13.42) completed questionnaires about sexuality, urinary function, and coping with uncorrected hypospadias. In addition, they answered the Medical Outcomes Study Short Form 36-item questionnaire (SF-36) to measure their health-related quality of life (HRQoL), the International Index of Erectile Function (IIEF) to measure their erectile function (EF), and the Penile Perception Score (PPS) to measure their genital self-perception. RESULTS: Men with uncorrected hypospadias had a significantly lower PPS and were significantly more often bothered by their penile appearance than were controls. However, they reported the same HRQoL, a comparable frequency and quality of sexuality, and the same EF. They did not hide their penis in public toilets more often than controls. Furthermore, they did not feel ridiculed more often due to their penis, nor did they feel more embarrassed during sexual contact. Almost all men (n = 37; 94.8 %) were able to void in a standing position. CONCLUSION: Our study indicates that some men with uncorrected distal hypospadias adapt well to their penile condition regarding their sexuality, HRQoL and voiding function. This indicates that not all men with uncorrected hypospadias suffer a psychological burden. However, our study also showed that men with uncorrected hypospadias had a lower genital self-perception and were more often bothered by their penile appearance compared to men without hypospadias. Therefore, delaying surgery of distal hypospadias beyond early childhood, until the affected individuals can give informed consent, may be a valid option for some individuals, particularly those with mild forms of distal hypospadias. The decision for or against surgery in early childhood must be considered carefully, and families must be supported in making their individual choices. This study has important limitations: The small group of unoperated men who volunteered to participate may be a selection of men who cope particularly well with their condition and therefore results may not be representative.
Ruppen-Greeff et al. (Fri,) studied this question.