Interesting new article on men with unrepaired hypospadias

[glongley]

I ran across a new article today that we can add to our store of information of hypospadias, and the relative need for repair. And guess what? It turns out that overall this group of men had no trouble with their penises and were quite happy with them just the way they were!

Here's the abstract:

Urology. 2008 Apr;71(4):682-5; discussion 685.
Adaptation of adults to uncorrected hypospadias.Dodds PR, Batter SJ, Shield DE, Serels SR, Garafalo FA, Maloney PK.

Department of Surgery, Norwalk Hospital, Norwalk, Connecticut 06856, USA. [e-mail]

OBJECTIVES: Surgery has been advocated for children with hypospadias to improve the appearance of the penis, allow voiding in the standing position, and improve the chance of fertility. We undertook a survey of adults with hypospadias to determine their adaptation to this congenital anomaly without surgical correction.

METHODS: In a 2-year prospective study, six urologists in the general practice of urology identified 56 adult patients from their practices with hypospadias. The urethral meatus was glanular in 21 patients, subcoronal in 23, distal penile in 7, mid-penile in 4, and proximal penile in 1. Nine patients had undergone failed or incomplete hypospadias repairs as children. Seven patients had mild to moderate chordee.

RESULTS: Only 1 patient presented with a complaint referable to the hypospadias, and only 3 (5%) of the 56 patients expressed dissatisfaction with the appearance of their penis. Of the 56 patients, 18 (32%) stated that they were unaware that they had a congenital anomaly. The 2 patients who were known to be infertile were believed to be infertile on the basis of oligospermia. Although 20 (36%) of the 56 patients described angulation or spraying of the urinary stream, only 3 (5%) stated that they preferentially sat to void. No patient pursued an interest in corrective surgery.

CONCLUSIONS: Of the adults we surveyed with hypospadias, most stated that they were satisfied with the appearance of the penis, voided in the standing position, and did not have infertility associated with the abnormal position of the urethral meatus.

There was an accompanying commentary that added the following:

"Although the take home message from this report certainly is not that we should stop doing hypospadias repairs, I think it is clear that we should not consider what we are doing is as major an essential contribution to the success of these boys as adults as perhaps we imagine."

I have the pdf if anyone wants to PM me for it.

Gillian

[Frankly Speaking]

This is not rocket science! Several years ago, I lurked on a discussion board for hypospadias/epispadias. Of the men who had not been repaired, almost all of them were happy/satisfied with the form, condition and function of their penis. None of them had any intent to have surgery to correct the condition.

I have had a number of mothers write me privately about their sons with hypospadias. The information I give them is that if the urethral opening is on the glans, they should just forget about it, that it is bothering them more than it will ever bother their son and there are substantial and significant complications from the surgery. Now, if the urethral opening is below the glans, there is a decision to be made and the further down the shaft it is, the more correction should be considered.


Frank