Sexual function in adolescence after childhood hypospadias repair: a patient-reported outcome study

Abstract

Objective: To present data on sexual function in post-pubertal patients after hypospadias surgery in childhood. Patients and Methods: We assessed 169 (96 distal, 20 midshaft, 53 proximal) patients with hypospadias born between 1991 and 2003, who underwent surgery before the age of 5 years. At a median (interquartile range) follow-up age of 16.2 (16.0–16.8) years, participants completed a pre-mailed sexual function questionnaire, including the Erection Hardness Score (EHS) during the last control visit. Dorsal Nesbit-like plication was used for curvature correction in 62 patients. Previously published normative data served as controls. Results: All patients reported having erections; 73% achieved EHS 4 (completely hard and fully rigid). In patients with distal hypospadias, EHS 4 was reported in 68% of cases, 85% of midshaft and 79% of proximal cases. Among those with and without curvature correction by Nesbit-like plication, EHS 4 was reported in 72% and 74%, respectively. The proportion reporting EHS 4 exceeded that of published controls (P < 0.01). Penile straightness during erection was reported by 95% of patients overall, with no significant differences across hypospadias subtypes or curvature correction status. Only one patient reported pain during ejaculation; none reported pain during erection. Ejaculation was reported by 95% of participants. Conclusion: Adolescents who underwent early hypospadias repair reported favourable sexual function outcomes, including high rates of erectile rigidity and ejaculatory function. Neither hypospadias severity nor the need for curvature correction affected these outcomes. These findings support the long-term sexual well-being of patients undergoing surgery for hypospadias in childhood.