title: Decisional regret after distal hypospadias repair: single institution prospective analysis of factors associated with subsequent parental remorse or distress.
abstract: OBJECTIVE
  Hypospadias repair is a commonly performed procedure. Little is known about decisional regret in parents who agree to proceed with this surgical reconstruction. We present data on this previously underexplored issue.
  
  
  METHODS
  We performed followup analysis of 100 couples prospectively evaluated after counseling for surgical correction of distal hypospadias in their son with assessment of complications and decisional regret 1 year after surgery. Findings were contrasted with baseline demographics, hypospadias knowledge and decisional conflict at the time of counseling.
  
  
  RESULTS
  Decisional regret was found in 116 parents, including mild regret in 41.4% and moderate to severe regret in 8.6%. There was no statistically significant difference in paired regret analysis between mothers and fathers. Complications were strongly associated with decisional regret (p <0.001). On regression analysis postoperative complications (OR 14.7, 95% CI 1.6-131.6), parental desire to avoid circumcision (OR 7.4, 95% CI 1.1-49.4) and initial decisional conflict level (OR 1.06, 95% CI 1.02-1.09) were statistically significant predictors of moderate to strong decisional regret. These findings remained robust after imputation strategies to address missing data. The impact of decisional conflict and preference for circumcision were significant even after excluding families who experienced complications.
  
  
  CONCLUSIONS
  To our knowledge this is the first study demonstrating parental decisional regret after providing consent for surgical correction of distal hypospadias in their son. Based on the described risk factors efforts aimed at minimizing complications and counseling about foreskin preservation techniques may be prudent to ameliorate decisional regret. The novel association between decisional conflict and regret suggests that conflict assessment during counseling may help screen families at risk for postoperative regret.
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada. Electronic address: armando.lorenzo@sickkids.ca.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada.
authors.forename: João L
authors.initials: JL
authors.lastname: Pippi Salle
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada.
authors.forename: Bozana
authors.initials: B
authors.lastname: Zlateska
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Koyle
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada.
authors.forename: Darius J
authors.initials: DJ
authors.lastname: Bägli
authors.affiliation: Divisions of Urology, Hospital for Sick Children and University of Toronto, Toronto and McMaster Children's Hospital and McMaster University (LHPB), Hamilton, Ontario, Canada.
authors.forename: Luis H P
authors.initials: LH
authors.lastname: Braga
mesh_terms: D000328:Adult; D002944:Circumcision, Male; D003657:Decision Making; D004644:Emotions; D006801:Humans; D007021:Hypospadias / Q000523:psychology / Q000601:surgery*; D007223:Infant; D008297:Male; D010290:Parents / Q000523:psychology*; D011183:Postoperative Complications / Q000523:psychology; D011446:Prospective Studies; D013520:Urologic Surgical Procedures / Q000523:psychology*
keywords: decision making; hypospadias; informed consent; reconstructive surgical procedures; urethra