Andersson et al. report the psychosocial and sexual outcomes for adolescents treated previously for proximal hypospadias. They hypothesised outcomes would be negatively affected compared to patients with distal hypospadias or age-matched controls (Swedish population registry). Participants answered a web-based questionnaire and were clinically assessed. Of 55 eligible patients with proximal hypospadias, only 33 (60%) with median age of 17.5 years (range 14-25.3) answered the questionnaire. As controls, 31/134 (23%) of patients post distal hypospadias surgery (median age 19 years) and 25/205 (12%) of age-matched controls (median age 18 years) completed the questionnaire.
Interestingly, patients with proximal hypospadias were found more likely to have received extra or specialised tutoring in school compared to those with distal hypospadias (P=0.024). There was good satisfaction with final meatal position and shape regardless of its final position (distal glanular, proximal glanular or coronal). Patients with proximal hypospadias (39%) were more dissatisfied with penile length than those with distal hypospadias (23%) or controls (12%); they did not experience a considerable increase in penile length during puberty. Occasional erectile difficulties (10% vs. 4%) and anejaculation (11% vs. 4%) were reported by patients with proximal hypospadias compared to controls. No differences were found in most aspects of psychosexual development or behaviour; nor were any differences in homo / bi / heterosexuality or gender identity noted. Mean age of sexual debut was comparable to a study of Swedish adolescents and half the patients with proximal hypospadias older than 16 years had begun engaging in sexual activity. Boys with proximal hypospadias require long-term surgical follow-up but may benefit from additional psychology input. The hypospadiologist should be reminded that a final meatal position at or near the glans is adequate for function / satisfaction and aiming for a more distal position could promote complications through creation of too much resistance and resultant dehiscence, fistulae or diverticulae.