Hypospadias: Psychosocial and Sexual Development and Consequences

Abstract

Hypospadias is a highly prevalent congenital anomaly, occurring in approximately 1/250 births. The impact of the defect and operative interventions on sexual and reproductive function has been addressed by few publications, although increased interest is nowadays shown about this difficult topic. It is essential to know the possible outcomes of intervention for appropriate counseling, operative planning, and follow-up. As the impact of the deformity extends beyond the realms of a structural defect, long-term evaluation is mandatory to assess all the repercussions of hypospadias surgery into puberty and adulthood. Until now, there was no prospective trial comparing the impact of various techniques on sexual outcome. There is considerable discordance in literature regarding the effects on sexual function. Some studies report important satisfaction of the patient and partner regarding the genitalia aspect, while some older studies mention dissatisfaction without objective measurement. Sexual dissatisfaction is often attributed to penile size but seems comparable to the general population without any penile congenital defect (Tack et al., J Sex Med, 2020). Ejaculatory disturbances range between 6 and 37% of operated individuals. There is no convincing evidence for impaired fertility. The long-term follow-up is essential to identify problems and to address them appropriately. Literature documenting the outcome of specific operative procedures and analysis based on severity of hypospadias will be informative. The long-term follow-up of the newer techniques which are more commonly used is awaited.