Abstract
BackgroundThe association between surgical outcome of hypospadias repair and long-term male reproductive function has not been documented. The purpose of this study was to clarify association between paternity in adult hypospadias patients and reoperation for urethral obstruction after two-stage repair during childhood.MethodsNinety hypospadias patients who underwent the same kind of two-stage repair in our institute by a single surgeon, were initially treated at < 18 years old, and who were ≥ 18 years old during the survey were included in the study. Present physical, social, and life status were evaluated by a mailed self-entry questionnaire, and clinical background and surgical outcome data were evaluated by medical records. National survey data of the general population were used as external control. The paternity rate of the patient groups was evaluated by Kaplan-Meier curve analysis and log-rank tests.ResultsTwenty-six patients (28.9%) underwent 43 reoperations after completion of the initial repair. Twelve patients were reoperated for obstructive complication (Study group) and were compared with 14 patients who were reoperated only for non-obstructive causes and 64 patients who were not reoperated as Study control group (N = 78). The Study group patients showed sexual intercourse rate and marriage rate not statistically different in comparison with the Study control, although marriage rate at 32.5 years old were lower than the general population (p = 0.048, z-test). None of the Study group achieved paternity, which showed a significant difference to the Study control (p = 0.032, log-rank test). The difference was also statistically significant in the analysis among the 31 married patients (p = 0.012, log-rank test). Patients reoperated for obstructive complication documented worsened Quality of Life score in the International Prostate Symptom Score (2.3 ± 2.0 vs. 1.4 ± 1.2, p = 0.031, t-test) and ejaculation problems (66.7% vs. 17.4%, p = 0.003, chi-square test).ConclusionsHistory of reoperation for obstructive complication was associated with lower paternity rate in patients with hypospadias, presumably for multifactorial causes associated with marriage age and ejaculation problems. The present results may implicate importance of uncomplicated urethroplasty during childhood for achieving paternity, although it should be further tested in the future for larger groups of hypospadias patients.
Highlights
The association between surgical outcome of hypospadias repair and long-term male reproductive function has not been documented
We reported that patients with hypospadias in general had equivalent intercourse and marriage rates compared with the general population [10]
Consistent with the findings of our previous study, the rates were equivalent to the general population data derived from the national survey [10, 15]
Summary
The association between surgical outcome of hypospadias repair and long-term male reproductive function has not been documented. Long-term consequences in patients with repaired hypospadias have been unclear. Several groups have recently conducted long-term follow-up studies, [4–9] and a Swedish group reported that sexual function and fertility of adult patients with hypospadias are equivalent to those of their age-matched controls but inferior in proximal type patients [7]. The intercourse rate was lower in patients with proximal hypospadias, and the marriage rate was lower in those without stable jobs. These were expected findings, but were statistically proven for the first time using multivariate survival analysis
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