Long-Term Followup of Hypospadias: Functional and Cosmetic Results

Purpose: We assessed long-term results after hypospadias surgery with respect to urinary and sexual function, cosmetic appearance and intimate relationships. Materials and Methods: We contacted 116 patients who are now adults and who underwent surgery between 1987 and 1992. Participation included mailed questionnaires containing the International Prostate Symptom Score, International Index of Erectile Function and the Dutch Survey of Intimate Relations (Nederlandse Relatie Vragenlijst) as well as uroflowmetry and cosmesis assessment using the Pediatric Penile Perception Score. A control group of 151 male students completed the International Prostate Symptom Score and International Index of Erectile Function, and underwent uroflowmetry. Results: A total of 91 patients (78%) were traceable, 57% returned the questionnaires and 27% visited the clinic. Hypospadias was distal, mid shaft and proximal in 47, 8 and 11 patients, respectively. International Prostate Symptom Score was greater than 7 in 9 of 64 patients (14%) compared to 10 of 151 controls (7%). Patients with distal hypospadias complained more about micturition. Patients with proximal hypospadias had lower maximum urine flow than other patients and controls. For sexuality the total International Index of Erectile Function did not differ between patients and controls. Patients with proximal hypospadias reported less satisfaction with penile length and objectively penile length was less than the average of all patients (10.8 vs 12.1 cm). Cosmetic outcome was considered satisfactory. Outcomes in the 33 patients who returned the Dutch Survey of Intimate Relations correctly were above average, especially for sexuality and independence. Conclusions: Patients with distal hypospadias have a higher International Prostate Symptom Score and patients with proximal hypospadias have lower maximum urine flow than controls. Sexual function and cosmesis are rated good. The quality of intimate relationships is above average.