Sexual well-being and penile appearance in adolescents operated for distal hypospadias in childhood

Eirik Gulseth; Andreas Urdal; Marit Helen Andersen; Ragnhild Sørum Falk; Gunnar Aksnes; Ragnhild Emblem; Anne Wæhre

doi:10.1016/j.jpurol.2023.03.001

Sexual well-being and penile appearance in adolescents operated for distal hypospadias in childhood

J Pediatr Urol. 2023 Jun;19(3):293.e1-293.e8. doi: 10.1016/j.jpurol.2023.03.001. Epub 2023 Mar 7.

Authors

Eirik Gulseth¹, Andreas Urdal², Marit Helen Andersen³, Ragnhild Sørum Falk⁴, Gunnar Aksnes², Ragnhild Emblem⁵, Anne Wæhre⁶

Affiliations

¹ Department of Pediatric Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Children's Surgical Department, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital, And Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: eirgul@ous-hf.no.
² Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway.
³ Department of Transplantation Medicine, Oslo University Hospital and Institute of Health and Society, University of Oslo, Oslo, Norway.
⁴ Oslo Centre for Biostatistics and Epidemiology, Research Support Service, Oslo University Hospital, Oslo, Norway.
⁵ Department of Pediatric Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁶ Department of Child and Adolescent Psychiatry, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway; Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

PMID: 36935329
DOI: 10.1016/j.jpurol.2023.03.001

Abstract

Background: The importance of patient-reported outcomes (PRO) in hypospadias is increasing. However, more knowledge is needed concerning genital self-perception on appearance and function in adolescents. The complication rates for distal hypospadias is different from that for severe hypospadias, and expected outcomes related to sexual well-being and cosmetics may also differ.

Objective: To investigate 16-year-olds' self-reported outcomes on penile appearance, sexual well-being, and voiding function in distal hypospadias, and compare with that of healthy male adolescents and a surgeon's view.

Study design: Sixteen-year-old patients operated for distal hypospadias were included in this cross-sectional study and compared to a group of healthy adolescents. The assessment tools included the adolescents' self-perception on genital appearance and function measured by Pediatric Penile Perception Score (PPPS) and their responses to a structured interview. We also included information on clinical data from the electronic medical records, together with a physical examination and an uroflowmetry.

Results: Seventy patients and 61 healthy adolescents participated. Patients and the comparison group reported no differences on sexual well-being. The patients were satisfied with penile appearance, however their overall PPPS was significantly lower (8.9), compared to the comparison group (9.6, p = 0.03). Thirty-nine percent of patients had complications leading to re-interventions and reported lower scores on genital self-perception on appearance and function compared to those who had not re-interventions. Voiding function was normal. The surgeon's score on appearance was comparable to the patients' score.

Discussion: A key finding in our study is the patients' high satisfaction on sexual well-being, which was similar to healthy adolescents. The patients were also satisfied with penile appearance but scored significantly lower than the comparison group. Surgeons and patients had comparable scores on appearance; however, they seemed to emphasize different aspects of appearance. Our results on penile appearance and sexual well-being are comparable to those of other studies on distal hypospadias. In our study, re-interventions were associated with more negative genital self-perception on appearance and function, similar to findings in other studies.

Conclusion: Our results show overall positive satisfaction on sexual well-being, voiding function and penile appearance despite less satisfaction on penile appearance when compared with the comparison group. Satisfaction was reported to be good also in patients experiencing re-interventions.

Keywords: Genital malformation; Hypospadias; Penile perception; Sexual well-being; Voiding function.