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Vavilov S, Roberts E, Smith GHH, Starkey M, Pockney P, Deshpande AV. Parental decision regret among Australian parents after consenting to or refusing hypospadias repair for their son: Results of a survey with controls. J Pediatr Urol 2022; 18:482-488. [PMID: 35659825 DOI: 10.1016/j.jpurol.2022.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/03/2022] [Accepted: 04/30/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child's hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underlying factors for decision-making, satisfaction, and regret. MATERIALS AND METHODS An online anonymous survey was administered to three groups of parents: 1) parents who consented for hypospadias repair, 2) parents who declined repair and 3) a control group who requested circumcision for their child. Operations occurred between 2010 and 2020 in two paediatric hospitals in New South Wales, Australia. The survey included a validated decision regret assessment tool and additional questions to explore the possible basis of the opinions. RESULTS One hundred and eighteen parents (invited - 381, completed - 116, response rate - 31%) participated in the survey. Decision regret was present in group 1 (n = 89) - 55% (moderate-to-severe 15%), in group 2 (n = 14) - 71% (moderate-to-severe 57%), and in the control group (n = 15) - 15% (moderate-to-severe 8%) of parents. There was a significant difference in the median decision regret score between all three groups. Parents who chose hypospadias repair were mostly concerned about function. CONCLUSIONS The prevalence of decision regret among Australian parents who consented for their son's hypospadias repair was lower compared with the mean decision regret reported in the literature to date (55% vs 65%). Decision regret and its severity were highest among parents who declined hypospadias repair. New strategies are needed to reduce decision regret in parents whether they elect for surgery or not.
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Affiliation(s)
- Sergey Vavilov
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia.
| | - Elysa Roberts
- Department of Occupational Therapy, School of Health Sciences, The University of Newcastle, NSW, Australia.
| | - Grahame H H Smith
- Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia; Department of Paediatrics and Child Health, The University of Sydney, NSW, Australia.
| | - Malcolm Starkey
- Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Research Alliance, Melbourne, VIC, Australia; School of Biomedical Sciences and Pharmacy, College of Health and Well Being, The University of Newcastle, NSW, Australia.
| | - Peter Pockney
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Discipline of Surgery, Medical School, The University of Western Australia, Perth, Australia.
| | - Aniruddh V Deshpande
- School of Medicine and Public Health, The University of Newcastle, NSW, Australia; Urology Unit, Department of Surgery, The Children's Hospital at Westmead, NSW, Australia; Faculty of Medicine, The University of Sydney, NSW, Australia.
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Gulseth E, Urdal A, Andersen MH, Diseth T, Aksnes G, Emblem R, Wæhre A. High satisfaction on genital self-perception and sexual function in healthy Norwegian male adolescents. J Pediatr Urol 2021; 17:555.e1-555.e8. [PMID: 33750647 DOI: 10.1016/j.jpurol.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/28/2021] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genital self-perception and self-reported outcome on sexual function represent important information in studies focusing on male adolescents born with a genital malformation. Normal data from an age-matched control group are essential for comparison and more knowledge is needed concerning age after puberty and before entering adulthood. OBJECTIVE To investigate the self-reported outcome on genital perception and sexual outcome of healthy male adolescents aged 16 and 17 years. STUDY DESIGN Sixty-one individuals were included in this cross-sectional study. The assessment tools included the adolescents' self-report on genital perception and sexual function measured by the Pediatric Penile Perception Score (PPPS) and their responses to a semi-structured interview. In addition, we added information on mental health and psychosocial functioning measured by the Strengths and Difficulties Questionnaire, and health-related quality of life (HRQoL) measured by the Pediatric Quality of Life Inventory. Body satisfaction and self-esteem were also measured by the Global Self-Worth and Physical Appearance subscales of the revised version of the Self-Perception Profile for Adolescents (SPPA). RESULTS Of the 73 individuals invited, a total of 61 participated. The adolescents reported high satisfaction on genital self-perception and sexual function with a score close to 10 on the overall PPPS score (maximum overall score is 12). Participants who were dissatisfied with their genitals reported penile length, alongside foreskin, as their main concern. More than 90% reported satisfaction on sexual function, concerning erection, masturbation, ejaculation, and orgasm. Results showed a higher score on body satisfaction, self-esteem, mental health and psychosocial functioning and a lower score on HRQoL compared to the normative Norwegian data. The small numbers of individuals that scored more negatively on genital self-perception and sexual function also scored more negatively in all items studied. DISCUSSION A key finding in our study was their high satisfaction on the overall PPPS score and reported sexual function. The results are comparable to other studies related to healthy male adolescents and the sample studied deviate little from a representative Norwegian sample. A comparison group of age-matched adolescents from the normative population is important to determine long-term outcomes on genital appearance and sexual function of patients born with a genital malformation and operated on in early childhood. Limitations of this study are the small sample-size and the lack of information on non-participants. CONCLUSIONS Our results show generally positive genital self-perception and sexual function in a healthy group of Norwegian male adolescents, aged 16 and 17.
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Affiliation(s)
- Eirik Gulseth
- 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.
| | - Andreas Urdal
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Marit Helen Andersen
- Department of Transplantation Medicine, Oslo University Hospital and Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Diseth
- Department of Child and Adolescent Psychiatry, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Gunnar Aksnes
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Emblem
- Department of Pediatric Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Wæhre
- Department of Child and Adolescent Psychiatry, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
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Ludovica D, Bianco M, Pelizzari A, Mandato F, Esposito C, Castagnetti M. Self-reported outcomes after the onset of puberty in patients undergoing primary distal hypospadias repair by the tubularized incised plate technique combined with preputial reconstruction vs. circumcision: A norm related study. J Pediatr Surg 2021; 56:1411-1416. [PMID: 33276974 DOI: 10.1016/j.jpedsurg.2020.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We assessed self-reported outcomes after the onset of puberty in patients undergoing tubularized incised plate (TIP) repair in combination with preputial reconstruction (PR) or circumcision for primary distal hypospadias, in comparison to normal controls. MATERIAL AND METHODS Out of 498 patients undergoing primary distal hypospadias repairs between 2001 and 2012, 83 underwent TIP repair associated with PR or circumcision before age 10-year, and had a Tanner stage ≥2 at study. Outcomes were assessed by online self-administration of validated questionnaires and additional non-validated questions. Results were compared between patients undergoing TIP repair vs. normal age-matched controls (healthy volunteers), and, between patients undergoing PR vs. circumcision. RESULTS Forty-one of the 83 eligible patients completed the study (response rate 49.3%). Of these, 26 had undergone PR. Median post-operative follow-up was 11.8 (range 6.5-16.2) years. The control group included 45 healthy boys. Comparing groups, there were no statistically significant differences in the cosmetic aspect of the penis, patient perception of penile appearance, and quality of life. Irrespective of preputial management, patients reported fear of being teased for the appearance of their genitalia much more commonly than controls (p = 0.02), but this did not affect their relationship patterns and quality of life. CONCLUSION Self-reported outcomes after the onset of puberty were not significantly different between patients undergoing primary TIP repair of distal hypospadias in childhood and normal controls. Patients were significantly more commonly feared of being teased for their genital appearance, but this did not interfere with their social skills. Preputial management, namely PR vs. circumcision, did not affect the outcome.
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Affiliation(s)
- Durante Ludovica
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via Giustiniani 2; Monoblocco Ospedaliero - 4th floor, Padua, Italy
| | - Marta Bianco
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via Giustiniani 2; Monoblocco Ospedaliero - 4th floor, Padua, Italy
| | - Anna Pelizzari
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via Giustiniani 2; Monoblocco Ospedaliero - 4th floor, Padua, Italy
| | - Francesco Mandato
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via Giustiniani 2; Monoblocco Ospedaliero - 4th floor, Padua, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Paediatric Urology Unit, Department of Surgery, Oncology, and Gastroenterology, University of Padova, Via Giustiniani 2; Monoblocco Ospedaliero - 4th floor, Padua, Italy.
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Bhatia VP, Mittal AG, Austin PF, Hilliard ME. The hypospadias-specific health-related quality of life conceptual framework: a scoping review of the literature. Qual Life Res 2021; 30:1537-1546. [PMID: 33559860 DOI: 10.1007/s11136-021-02773-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) is an important yet understudied construct for individuals with hypospadias (HS). An important barrier towards understanding HRQoL and integrating it into research and clinical care for people with HS is the absence of an underlying conceptual framework to illustrate this construct. We propose a conceptual framework for HS-specific HRQoL based upon a scoping review of the HS literature. METHODS/MATERIALS We conducted a literature review of articles published between 1989 and 2019. Our search in Embase and Pubmed used the keyword "hypospadias" in combination with "quality of life" and "patient-reported outcomes." We used thematic analysis of the resulting publications to identify core HRQOL domains. From these results and review of HRQoL literature in other pediatric populations, we developed a conceptual framework representing HS-specific HRQoL. RESULTS We identified five domains of HRQOL previously studied in research with youth and adults with HS: penile appearance, voiding, social interaction, sexual health, and psychological or behavioral function. We propose a model of HS-specific HRQoL comprised of these domains and their areas of overlap, based upon the findings and conceptual mapping of our literature review. CONCLUSION This novel conceptual framework provides a foundation for understanding disease-specific HRQoL in individuals with HS and may serve as a guide for the conduct of future qualitative studies of the HS population. The overlapping biopsychosocial domains illustrate the possible effects of HS on day-to-day life. This framework may guide future surgical, clinical, and behavioral interventions that aim to improve medical care and quality of life outcomes for HS patients.
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Affiliation(s)
- V P Bhatia
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA. .,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA.
| | - A G Mittal
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA
| | - P F Austin
- Division of Urology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.,Scott Department of Urology, Baylor College of Medicine, 6701 Fannin Street, MS 3340, Houston, TX, 77030, USA
| | - M E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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Evaluating quality of patient-reported outcome measures in patients with hypospadias. J Pediatr Urol 2021; 17:50-58. [PMID: 33371965 DOI: 10.1016/j.jpurol.2020.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/28/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There is growing recognition of the importance of patient-reported outcomes (PROs) in pediatric hypospadias. We have previously presented a conceptual framework for Hypospadias-Specific Health-Related Quality of Life (HRQoL), which posited 5 domains of HRQoL in this population. The framework components (domains) included penile appearance, voiding function, social function, psychological/behavioral function, and pubertal/sexual health. In this work, we investigated the established validity and relevance of PROs within each of these domains for patients with hypospadias. MATERIALS AND METHODS We evaluated existing measures with published psychometric data, including validation data, in the hypospadias population. We also assessed the available data on each measure according to the guidelines of the Scientific Advisory Committee of the Medical Outcomes Trust (Table) in order to establish measure quality. We also examined the power of existing validation studies according to suggested guidelines for psychometric validation and factor analysis. DISCUSSION Available validated measures in the hypospadias population have focused primarily on penile appearance and to a lesser degree on pubertal development/sexual health. There were no validated disease-specific measures with dedicated evaluations of other key HRQoL domains including voiding-related sequelae, social function, or psychological function. In addition, no single measure addressed all of the quality guidelines posed by the Scientific Advisory Committee. CONCLUSIONS Current generalized measures for PROs lack relevance to the experience of hypospadias patients, and disease-specific assessments are often focused on penile appearance. Improving measure quality is necessary to optimize the value of our assessments and better help our patients with hypospadias.
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Koven A, O'Kelly F, El-Ghazzaoui A, Langer JC, Levin D, Diamond A, Goldstein Y, Reichman E, Koyle MA. Bringing Jewish Ritual circumcision (Brit Milah) Into the Operating Room: An Analysis of Surgical Outcomes and Satisfaction Across Families and Society of Pediatric Urology members. Urology 2021; 154:243-248. [PMID: 33482127 DOI: 10.1016/j.urology.2020.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess caregiver satisfaction, procedural outcomes and practitioner opinion regarding a novel program designed for patients to undergo a deferred Jewish ritual circumcision (Brit Milah) in the operating room (OR), combined with other indicated surgical procedures. METHODS All patients undergoing Brit Milah in the OR at our institution between 2013 and 2019 were included. Surveys were administered to assess caregiver satisfaction and Society for Pediatric Urology member practice patterns. A retrospective case-control series was completed to compare complication rates and operative times for procedures with and without Brit Milah. RESULTS Forty-four intraoperative Brit Milah patients were identified. The mean procedure time for a distal hypospadias repair with Brit Milah was 66.0 minutes, compared to 62.4 minutes without (P = .57). No complications were attributable to the addition of Brit Milah. The caregiver survey had a 100% response rate. The modal response for satisfaction with the perioperative experience was 5 of 5 (ie, highly satisfied), with 100% of respondents very likely to recommend the program. 132 active Society for Pediatric Urology members responded to the survey (34.1% response rate) with 44% regularly allowing Brit Milah in the OR at their institution. 90.5% received positive caregiver feedback and 64% believe it is important to offer. CONCLUSION This novel program incorporating Brit Milah into the OR yields high caregiver satisfaction, no additional OR time or postoperative complications, and provides an opportunity to combine family-centered care with cultural competence.
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Affiliation(s)
- Alexander Koven
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Fardod O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ali El-Ghazzaoui
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Levin
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aubie Diamond
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Abraham Diamond Medicine Professional Corporation, Toronto, Ontario, Canada
| | - Yisroel Goldstein
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ezriel Reichman
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Tack LJ, Springer A, Riedl S, Tonnhofer U, Weninger J, Hiess M, Van Laecke E, Hoebeke P, Spinoit AF, Cools M, Van Hoecke E. Psychosexual Outcome, Sexual Function, and Long-Term Satisfaction of Adolescent and Young Adult Men After Childhood Hypospadias Repair. J Sex Med 2020; 17:1665-1675. [DOI: 10.1016/j.jsxm.2020.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
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Affiliation(s)
- Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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