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Lammers RJM, Tsachouridis G, Andersson MK, Dormeus S, Ekerhult TO, Frankiewicz M, Gunn CJ, Matuszewski M, de Mooij KL, Schroeder RPJ, Wyndaele MIA, Xing Z, De Kort LMO, de Graaf P. What should be next in lifelong posterior hypospadias: Conclusions from the 2023 ERN eUROGEN and EJP-RD networking meeting. Neurourol Urodyn 2024; 43:1097-1103. [PMID: 38289328 DOI: 10.1002/nau.25305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND A congenital disease is for life. Posterior hypospadias, the severe form of hypospadias with a penoscrotal, scrotal, or perineal meatus, is a challenging condition with a major impact on lifelong quality of life. AIM Our network meeting is aimed to identify what is currently missing in the lifelong treatment of posterior hypospadias, to improve care, quality of life, and awareness for these patients. METHODS The network meeting "Lifelong Posterior Hypospadias" in Utrecht, The Netherlands was granted by the European Joint Programme on Rare Diseases-Networking Support Scheme. There was a combination of interactive sessions (hackathons) and lectures. This paper can be regarded as the last phase of the hackathon. RESULTS Surgery for hypospadias remains challenging and complications may occur until adulthood. Posterior hypospadias affects sexual function, fertility, and hormonal status. Transitional care from childhood into adulthood is currently insufficiently established. Patients should be more involved in defining desired treatment approach and outcome measures. For optimal outcome evaluation standardization of data collection and registration at European level is necessary. Tissue engineering may provide a solution to the shortage of healthy tissue in posterior hypospadias. For optimal results, cooperation between basic researchers from different centers, as well as involving clinicians and patients is necessary. CONCLUSIONS To improve outcomes for patients with posterior hypospadias, patient voices should be included and lifelong care by dedicated healthcare professionals guaranteed. Other requirements are joining forces at European level in uniform registration of outcome data and cooperation in basic research.
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Affiliation(s)
- Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - George Tsachouridis
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Marie K Andersson
- Department of Pediatric Surgery, Sahlgrenska Academy, Women's and Children's Health, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Sarah Dormeus
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Teresa O Ekerhult
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Callum J Gunn
- Department of Bioethics and Health Humanities, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Keetje L de Mooij
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Rogier P J Schroeder
- Department of Pediatric Urology, Wilhemina Kinderziekenhuis, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Zhentao Xing
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Laetitia M O De Kort
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
| | - Petra de Graaf
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, Utrecht, The Netherlands
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Ceccarelli PL, Lucaccioni L, Poluzzi F, Bianchini A, Biondini D, Iughetti L, Predieri B. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr 2021; 21:523. [PMID: 34836527 PMCID: PMC8620229 DOI: 10.1186/s12887-021-02941-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Hypospadias is one of the most common congenital abnormalities in male newborn. There is no universal approach to hypospadias surgical repair, with more than 300 corrective procedures described in current literature. The reoperation rate within 6–12 months of the initial surgery is most frequently used as an outcome measure. These short-term outcomes may not reflect those encountered in adolescence and adult life. This study aims to identify the long-term cosmetic, functional and psychosexual outcomes. Methods Medical records of boys who had undergone surgical repair of hypospadias by a single surgical team led by the same surgeon at a single centre between August 2001 and December 2017 were reviewed. Families were contacted by telephone and invited to participate. Surgical outcome was assessed by combination of clinical examination, a life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5). Outcomes were compared according to age, severity of hypospadias, and respondent (child, parent and surgeon). Results 187 children and their families agreed to participate in the study. 46 patients (24.6%) presented at least one complication after the repair, with a median elapsed time of 11.5 months (6.5–22.5). Longitudinal differences in surgical corrective procedures (p < 0.01), clinical approach (p < 0.01), hospitalisation after surgery (p < 0.01) were found. Cosmetic data from the PPS were similar among children and parents, with no significant differences in child’s age or the type of hypospadias: 83% of children and 87% of parents were satisfied with the cosmetic result. A significant difference in functional outcome related to the type of hypospadias was reflected responses to HOSE amongst all groups of respondents: children (p < 0.001), parents (p=0.02) and surgeon (p < 0.01). The child’s HOSE total score was consistently lower than the surgeon (p < 0.01). The HOSE satisfaction rate on functional outcome was 89% for child and 92% for parent respondents. Conclusion Surgeons and clinicians should be cognizant of the long-term outcomes following hypospadias surgical repair and this should be reflected in a demand for a standardised approach to repair and follow-up.
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Affiliation(s)
- Pier Luca Ceccarelli
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Francesca Poluzzi
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Anastasia Bianchini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Diego Biondini
- Pediatric Surgical Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy.
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, via del Pozzo 71, 41124, Modena, Italy
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Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res 2020; 33:149-163. [PMID: 33262531 DOI: 10.1038/s41443-020-00377-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/13/2023]
Abstract
Hypospadias is a common abnormality of the urogenital tract with a wide range of variety in its presentation and severity. The primary aim to correct hypospadias is to restore normal penile function and appearance. Although it can be corrected at any age, early correction between the 6 and 18 months of life is recommended. The functional and cosmetic outcomes have been very-well presented in the literature, although the aspects of sexuality and fertility of hypospadias repair in the long term are vague. In this narrative review, we aimed to gather the data around the sexuality and fertility outcomes of hypospadias repair and acknowledge urologists and parents of boys with hypospadias who will have a correction surgery about future sexual and fertility concerns.
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