title: Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes.
abstract: OBJECTIVE
  Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes.
  
  
  METHODS
  Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents.
  
  
  RESULTS
  Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup.
  
  
  CONCLUSIONS
  Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients.
authors.affiliation: Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Ghidini
authors.affiliation: Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy.
authors.forename: Sasa
authors.initials: S
authors.lastname: Sekulovic
authors.affiliation: Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy. Electronic address: marcocastagnetti@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Castagnetti
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D004644:Emotions; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult
keywords: decision making; hypospadias; informed consent; reconstructive surgical procedures; urethra