title: Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes.
abstract: BACKGROUND
  Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias.
  
  
  METHODS
  A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery.
  
  
  RESULTS
  A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity.
  
  
  CONCLUSIONS
  Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.
authors.affiliation: Department of Applied Health, Faculty of Health, Edge Hill University, Ormskirk, Lancashire, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Adams
authors.affiliation: Formerly at the Dudley Group of Hospitals, West Midlands, UK.
authors.forename: Aivar
authors.initials: A
authors.lastname: Bracka
keywords: Cosmetic; genital image; genital surgery; hypospadias; long-term outcome; penis size; psychosocial; reconstructive surgery