Better Defining the Spectrum of Adult Hypospadias: Examining the Effect of Childhood Surgery on Adult Presentation.
OBJECTIVE
To describe the spectrum of adult presentations with hypospadias-related complications and examine the effect of childhood surgical repair on these adult presentations.


METHODS
A retrospective chart review over a 10-year period, from August 2004 to December 2014, demonstrated 93 adult patients who presented to a reconstructive urologist with complications related to hypospadias. Patients were divided into 2 groups: those with no prior hypospadias surgery (Group 1, N = 19) and those who underwent surgical correction as a child (Group 2, N = 74). Charts were reviewed for age at presentation, initial complaints, history of repair, and surgical intervention required.


RESULTS
The mean age at presentation was 34.6 ± 0.6 years. Overall, lower urinary tract symptoms (LUTS) (49%) was the most common presenting complaint, followed by spraying (24%), urethrocutaneous fistula (18%), recurrent urinary tract infections (UTIs) (15%), and chordee (14%). Comparison demonstrated that Group 2 patients were more likely to present with LUTS (55% vs 26%; P = .038) and recurrent UTIs (19% vs 0%; P = .050). There was a trend toward Group 1 patients presenting more commonly with cosmetic dissatisfaction (16% vs 4%; P = .06). Urethral stricture was demonstrated more commonly in Group 2 (47% vs 11%; P = .0043). Of these, strictures were significantly longer in the previous surgery group (5.5 ± 0.6 cm vs 3.0 ± 0.6 cm, P = .019).


CONCLUSIONS
Correction of hypospadias as a child likely increases the future risk of urethral stricture, recurrent UTIs, and subsequent LUTS, with a trend toward improving patient satisfaction with cosmesis compared to nonsurgical management. Follow-up of hypospadias repair patients should extend into adulthood, as a significant portion of adult presentations ultimately require surgical intervention.
Division of Urology, University of Alberta, Edmonton, AB, Canada.
Nathan Y
NY
Hoy
Division of Urology, University of Alberta, Edmonton, AB, Canada. Electronic address: keithrourke@shaw.ca.
Keith F
KF
Rourke
D000328:Adult; D000416:Alberta / Q000453:epidemiology; D002648:Child; D017577:Cutaneous Fistula / Q000453:epidemiology / Q000209:etiology; D005544:Forecasting; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D015994:Incidence; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000453:epidemiology / Q000209:etiology; D014548:Urinary Fistula / Q000453:epidemiology / Q000209:etiology; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects