Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark.
Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
J Pediatr Urol. 2022 Aug;18(4):480.e1-480.e7. doi: 10.1016/j.jpurol.2022.06.008. Epub 2022 Jun 11.
Hypospadias surgery undertaken in early life often continues to impose challenges as patients age. Little is known about the natural history of uncorrected hypospadias persisting into adulthood.
To describe presenting symptoms and management strategies in men with uncorrected hypospadias referred to our national tertiary transitional clinic for congenital urological conditions.
Patients with uncorrected hypospadias older than 16 years at the time of referral were identified by searching the electronic patient record system for ICD-10 hypospadias codes. Data were extracted over a 10-year period according to a predefined protocol.
Among 201 referrals, 65 men with hypospadias (glanular n = 12, coronal n = 26, subcoronal n = 9, corporal n = 4, penoscrotal n = 2 and MIP n = 12) had never previously had reconstructive surgery undertaken. Obstructive symptoms predominated (n = 30) and the risk of symptoms increased with advancing age (Figure). Presenting complaints varied across the age span; cosmetic issues (n = 11) and coital pain (n = 5) were primarily seen in youth as opposed to urinary obstructive symptoms that were increasingly more frequent with age (p = 0.002) (Figure). Management included reconstructive surgery (n = 24), minor procedures (preputioplasty, circumcision, meatoplasty, dilatation/urethrotomy, total n = 28) as well as counselling (n = 12). The management strategies were independent of age and hypospadias type.
The current cohort delineates the dynamic nature of hypospadias in itself. We speculate that the distinction in the primary complaint leading to referral between the extremes of age may relate to the vanity and insecurity of youth while older patients first come forward when other symptoms arise. Dissatisfaction with genital appearance is uncommon in previous smaller studies on men with uncorrected hypospadias unlike in our study, where 11 patients were assessed mainly for cosmetic concerns. Obstruction is the main symptom encountered in adult hypospadias patients operated in early life, and a similar picture was observed in our cohort of unoperated cases. Urethral dilatation and internal urethrotomy are temporizing procedures but were successful in immediate alleviation of obstructive symptoms in patients not willing to consign themselves to formal surgery. The study is limited by its retrospective design, and our symptomatic cohort may also represent the extreme end of the hypospadias spectrum.
Medical issues vary across the age span in men with unrepaired hypospadias. Minor surgical procedures as well as counselling play an equally important role as reconstructive hypospadias surgery in the management of unrepaired hypospadias in adulthood.
在生命早期进行的尿道下裂手术随着患者年龄的增长仍会持续面临挑战。对于未矫正的尿道下裂持续到成年期的自然病史知之甚少。
描述我们国家三级过渡性先天性泌尿科疾病诊所转诊的未矫正尿道下裂男性患者的临床表现和管理策略。
通过搜索 ICD-10 尿道下裂代码的电子病历系统，确定了在转诊时年龄超过 16 岁的未矫正尿道下裂患者。根据预先设定的方案，在 10 年内提取数据。
在 201 例转诊患者中，有 65 例男性（尿道下裂患者 65 例，其中 12 例为龟头型，26 例为冠状型，9 例为冠状下型，4 例为阴茎体型，2 例为阴阴囊型，12 例为阴茎阴囊型）从未接受过重建手术。以梗阻性症状为主（n=30），且随着年龄的增长，症状的风险增加（图）。临床表现因年龄而异；在年轻人中主要表现为美容问题（n=11）和性交疼痛（n=5），而随着年龄的增长，梗阻性症状越来越频繁（p=0.002）（图）。治疗包括重建手术（n=24）、小手术（包皮成形术、包皮环切术、肉膜成形术、扩张/尿道切开术、共 n=28）以及咨询（n=12）。管理策略与年龄和尿道下裂类型无关。
目前的队列描述了尿道下裂本身的动态性质。我们推测，在极端年龄之间导致转诊的主要投诉之间的区别可能与年轻人的虚荣和不安全感有关，而老年患者则在出现其他症状时首先出现。与以前的未矫正尿道下裂男性的小型研究不同，我们的研究中 11 名患者主要因生殖器外观不满意而就诊，并不常见。在早期接受手术的成年尿道下裂患者中，梗阻是主要症状，我们未手术的患者中也观察到了类似的情况。尿道扩张和尿道内切开术是临时手术，但在不愿接受正式手术的患者中，可成功立即缓解梗阻症状。该研究受到其回顾性设计的限制，我们的症状性队列也可能代表尿道下裂谱的极端。
在未矫正的尿道下裂男性中，医疗问题在不同年龄段有所不同。在未矫正的尿道下裂成年患者的管理中，小手术和咨询与重建尿道下裂手术同样重要。
