Selvi Ismail, Dönmez M İrfan, Aydın Ahmet Barış, Oktar Tayfun, Ziylan Orhan
Division of Pediatric Urology, Department of Urology, İstanbul University, İstanbul Faculty of Medicine, Istanbul, Turkey.
Department of Urology, Koç University, School of Medicine, Istanbul, Turkey.
Int J Impot Res. 2024 Aug 27. doi: 10.1038/s41443-024-00971-x.
This study aimed to assess the cosmetic and sexual outcomes of childhood hypospadias repair after puberty. Among 672 patients who underwent hypospadias repair between 2001 and 2017, 243 sexually active patients were included in the study. At their last visit, cosmetic and sexual evaluation were done through the Penile Perception Score, the Hypospadias Objective Scoring Evaluation, IIEF, MSHQ-EjD. The levels of erectile dysfunction(ED) severity were determined according to erectile function domain of IIEF. The median follow-up after the last surgery was 16 [IQR (13-18)] years, and median patient age at the time of study was 19.67 [IQR(18-22)] years. Patients were divided into two subgroups as follows: Group I; Repairs using grafts (n = 120, 49.4%) and Group II; Graft-free repairs (n = 123, 50.6%). The rate of dissatisfaction with penile appearance was higher in Group I (16.7% vs. 4.9%, p = 0.003). Mild ED was more frequent in Group I (14.2% vs. 3.3%, p = 0.007); while none of the patients had either moderate or severe ED. Other domains of sexual function were observed to be similar in both groups. The need for unwanted interventions due to complications, and surgeries requiring grafts were found to be risk factors for ED development and dissatisfaction with penile appearance in adulthood. Those who underwent graft-free hypospadias repair experience better cosmetic and sexual outcomes when compared to grafted repairs, yet, satisfactory results were achieved in almost 90% of the grafted repairs.
本研究旨在评估青春期后小儿尿道下裂修复术的美容和性功能结果。在2001年至2017年间接受尿道下裂修复术的672例患者中，243例性活跃患者纳入本研究。在他们最后一次就诊时，通过阴茎感知评分、尿道下裂客观评分评估、国际勃起功能指数（IIEF）、男性性功能障碍问卷-射精功能障碍版（MSHQ-EjD）进行美容和性功能评估。根据IIEF的勃起功能领域确定勃起功能障碍（ED）严重程度水平。最后一次手术后的中位随访时间为16[四分位间距（IQR）（13 - 18）]年，研究时患者的中位年龄为19.67[IQR（18 - 22）]岁。患者分为以下两个亚组：第一组；使用移植物修复（n = 120，49.4%）和第二组；无移植物修复（n = 123，50.6%）。第一组对阴茎外观不满意的发生率更高（16.7%对4.9%，p = 0.003）。第一组轻度ED更常见（14.2%对3.3%，p = 0.007）；而没有患者有中度或重度ED。两组性功能的其他领域观察到相似。因并发症而进行不必要干预的需求以及需要移植物的手术被发现是成年期ED发生和对阴茎外观不满意的危险因素。与使用移植物修复相比，接受无移植物尿道下裂修复的患者在美容和性功能方面有更好的结果，然而，几乎90%的使用移植物修复也取得了满意的结果。
