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Hypospadias: Patient/Parent Perception of Functional and Cosmetic Outcomes

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Angela D. Gupta, M.D., Urology, Johns Hopkins Medical Institutions, Baltimore, MD, Kristina D. Suson, Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, MD and Ranjiv Mathews, MD, Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD


Hypospadias is a congenital anomaly of the penis, resulting in a nonorthotopic urethral meatus, chordee, and hooded foreskin.  Surgical repair is the standard of care, with a goal of creating a functional penis that allows normal voiding, straight erection and a cosmetically normal appearance.  The purpose of this study was to evaluate patient/parent perception of functional and cosmetic outcomes. 


Following IRB approval, patients in the outpatient clinic over a 10 year period with the billing codes of hypospadias, urethrocutaneous fistula, and meatal stenosis were identified. A 7-item questionnaire assessing functional and cosmetic outcomes was sent to each family. 


712 patients were contacted. 139 questionnaires were returned demonstrating a 19.5% response rate.  112 (81%) of the responses were completed on patients who had undergone hypospadias repair.   Most respondents indicated functional normal voiding without spraying (73%), splitting (80%) and a good strength of stream (75%).  76% of the patients achieved a satisfactory functional outcome after their first completed repair. 63% were completely satisfied with the final cosmetic outcome, 31.2 % were partly satisfied, and 5.3% were dissatisfied. Given a choice, 24.1 % of parents/patients would consider having another procedure to improve the cosmesis, while 55.3% would not consider further surgery. 84% of respondents would have re - elected to have the hypospadias corrected.  24% of patients underwent at least one additional procedure. 

Based on the location of the initial urethal meatus – proximal versus distal; normal voiding without spraying was reported in 50%, splitting 75%, and a strong stream 67% of proximal vs 80%, 83% and 78%  of distal defects.  62.5% of those with a proximal and 66% of those with a distal defect, were pleased with the cosmesis.  92% of the proximal group and 82% of the distal group would have elected to have the procedure again.

The age at reconstruction seemed to impact outcomes with boys >2 years at reconstruction having less favorable outcomes. Spraying of urine and a consistent strong stream was noted in 45% and 63% respectively of those having surgery at >2 years of age as compared to <30% and 75% respectively in those having surgery at < 2 years of age.


Surgical repair of hypospadias does provide a good functional and cosmetic outcome, however from the patient/parent’s perspective, the outcomes are not always as perfect as would be suggested by provider’s evaluation of the outcomes. It is important to counsel parents regarding cosmetic and functional outcomes. Providers should be aware that parental and patient perception of outcomes may differ from their own.