Adolescent Satisfaction and Decisional Regret After Hypospadias Repair in Early Childhood

Abstract

Objective To evaluate adolescent satisfaction and decisional regret after hypospadias repair in childhood and to assess associations with anatomical severity, surgical complications, and reoperations. Patients and Methods Adolescents who underwent hypospadias repair in childhood completed a pre-mailed questionnaire before their final pediatric follow-up visit. Satisfaction was assessed using the validated Penile Perception Score (PPS), evaluating meatal location, glans shape, penile skin, and overall appearance. Additional items addressed satisfaction with penile length and straightness, perceived timing of surgery, and decisional regret. Reference data for age-matched healthy controls were derived from published normative material. Results In total, 176 patients (101 distal, 20 midshaft, and 55 proximal hypospadias) responded (response rate 64%); 51% had undergone at least 1 unplanned reoperation. Median age at primary surgery was 1.4 years and at follow-up, 16.3 years. Dissatisfaction with meatal location, glans, skin, and straightness did not differ between patients and controls. Dissatisfaction with penile length (18.6% vs 0%, P < .01) and overall appearance (11.8% vs 1.6%, P = .03) was more common among patients. PPS scores were generally higher after distal than proximal repair. Dissatisfaction with penile length was more frequent after a Nesbit procedure (26% vs 12%, P = .03). Most patients (89.8%) considered the timing of surgery appropriate; 2.9% reported decisional regret. Conclusion Most adolescents were satisfied with outcomes following early hypospadias repair. Dissatisfaction with penile length and appearance was more frequent among patients, especially after proximal repair. Decisional regret was rare, supporting early surgery combined with structured long-term follow-up and appropriate counseling.