RECONSTRUCTIVE UROLOGY

Sexual behavior and sexual function of adults after hypospadias surgery: a comparative study
Bubanj TB, Perovic SV, Milicevic RM, Jovcic SB, Marjanovic ZO, Djordjevic MM
Department of Pediatric Urology, University Children’s Hospital, Clinical Center, Nis, and University Children’s Hospital Belgrade, Serbia and Montenegro
J Urol. 2004; 171: 1876-9

• Purpose: We assessed sexual behavior and sexual function in adults operated on for hypospadias.
• Materials and Methods: Long-term psychosexual adjustment was assessed with a standardized questionnaire which was mailed to 57 patients with hypospadias older than 18 years and 60 age matched normal control subjects.
• Results: A total of 37 patients with hypospadias and 39 controls participated. Self-reported strength of libido on a scale of 1 to 5 was shown to be similar in the 2 groups. Patients with hypospadias did not have problems in achieving erection and average self-rated quality of erection ranging from 1 to 5 was the same as that of controls (mean value 4.5). Patients with hypospadias noted curvature in a downward direction in a significantly higher proportion compared to controls (40% vs 18%, respectively). There were 13 patients with hypospadias who had ejaculation difficulties, of whom 6 had spraying and 7 had only dribbling of ejaculate. Patients with hypospadias masturbated significantly less often, were significantly less sexually active and had a smaller total number of sexual partners compared to control subjects. Control subjects were significantly more completely satisfied with their sexual life compared to patients with hypospadias (76.92% vs 51.35%, respectively).
• Conclusions: Sexual function of patients who underwent surgery for hypospadias in general is not affected. However, there is clearly a difference in certain aspects of sexual behavior between patients with hypospadias and controls. Followup and adequate counselling of patients who underwent surgery for hypospadias in adult life is necessary.
  
  
• Editorial Comment
  This is a nice paper dealing with late functional aspects after early hypospadias repair. Most of the previous papers are dealing with the results regarding general appearance and urethral function in the first few years after the reconstruction. Few authors, however, thought about consequences on sexual behaviour and sexual function in adulthood.
  The authors studied 57 men between the age of 20 and 45 (mean age 27 yrs) who were treated surgically for hypospadias 2 to 15 yrs prior to the study. Several aspects of sexual behaviour and function were compared with an age matched control group of 39 men. There was no significant difference with regards to sexual function between the 2 groups. However, men with a previous surgery for hypospadias were less sexually active, with a smaller total number of sexual partners and a decreased overall satisfaction of their sexual life compared to control subjects. Whether this was related to a downward direction of the penis, ejaculation difficulties or a reduced penile size in a significantly higher proportion of the patients or whether some differences in hormonal values might have played a role could not be answered in this paper.
  Despite some positive aspects in the outcome with regards to sexual function of patients with hypospadias repair we as reconstructive surgeons should be aware of possible improvements of surgical techniques such as penile length and diameter in order to avoid some of the problems in later sexual behaviour and cosmetics as here outlined.

Dr. Arnulf Stenzl
Professor and Chairman of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany