title: Long-term patient reported outcome and satisfaction after oral mucosa graft urethroplasty for hypospadias.
abstract: OBJECTIVE
  There is a paucity of long-term patient reported outcome data on surgery for hypospadias. We sought to evaluate genitourinary function and satisfaction after oral mucosa graft urethroplasty (OMGU) for hypospadias.
  
  
  METHODS
  We identified 65 patients who had undergone OMGU at our institution between 1992 and 2003, and surveyed these patients to evaluate oral health, urinary function and satisfaction with outcomes.
  
  
  RESULTS
  We located 51 patients who had undergone OMGU, of whom 43 (84%) agreed to participate in the study. Median followup was 6.9 years. Mean study age was 15.1 years. Of the patients 47% had severe hypospadias with failed previous repair and 42% had severe hypospadias with previous first stage surgery. Oral complaints were rare and primarily cosmetic. No patient whose oral harvest was limited to the cheek (vs lip) had cosmetic complaints. Urinary spray and stream deviation were reported by 11 patients (26%) and 12 patients (28%), respectively. American Urological Association symptom scores were generally low (mean 5.6 +/- 6.0, range 0 to 21) but 7 patients (16%) had moderate symptoms and 2 (5%) had severe symptoms. Of the patients 60% were mostly satisfied or better with urinary function. Although satisfaction with penile appearance varied (51% of patients were satisfied), most patients (84%) were satisfied with the overall hypospadias care. Urinary symptom scores were significantly worse among patients who had post-OMGU complications (p = 0.004). Of these patients 38% had moderate or severe urinary symptoms, while 95% of patients without complications had mild symptoms (p = 0.01).
  
  
  CONCLUSIONS
  Many patients report good long-term outcomes of OMGU, although a subset of patients has significant urinary and cosmetic complaints that are more prevalent in association with surgical complications.
authors.affiliation: Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. cnelso32@jhmi.edu
authors.forename: Caleb P
authors.initials: CP
authors.lastname: Nelson
authors.forename: David A
authors.initials: DA
authors.lastname: Bloom
authors.forename: Robert
authors.initials: R
authors.lastname: Kinast
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
authors.forename: John M
authors.initials: JM
authors.lastname: Park
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001828:Body Image; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D017060:Patient Satisfaction; D010413:Penis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D020858:Tissue and Organ Harvesting; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014555:Urination Disorders / Q000175:diagnosis / Q000209:etiology; D014563:Urodynamics