Patient Satisfaction with Surgical Outcome after Hypospadias Correction

Abstract

BackgroundHypospadias is a congenital malformation in which surgical correction is indicated in most cases. Postoperative patient satisfaction is important because of its influence on the child's psychological development. ObjectiveTo evaluate patient satisfaction with surgical outcome after hypospadias correction, comparison with physician satisfaction, and the influence of patient and treatment characteristics on satisfaction. Design, setting, and participantsSeventy-four patients who had hypospadias surgery between 1996 and 2010 in Medical Centre Leeuwarden participated in the study. MeasurementsPatient/parent and physician satisfaction scores were measured using a standardised hypospadias satisfaction questionnaire (maximum score 32), and clinical outcome using the Hypospadias Objective Scoring Evaluation (HOSE; maximum score 16). Patient and treatment characteristics recorded were: preoperative meatal location, preoperative chordee, number of planned surgeries, reconstructive type and timing, patient age during the study, complications, and repeat operations. Results and limitationsPatients (mean age 10.5 yr) had a lower overall satisfaction score (27.1) than the physicians (30.6). Patients were least satisfied with overall genital appearance (3.1), penile length (3.3), and scars (3.3), whereas physician satisfaction was lowest for scars (3.5). The mean HOSE was 15.4 (standard deviation 0.9). Patients with acceptable HOSE (85%) had higher patient and physician satisfaction compared to patients with unacceptable HOSE. Patient satisfaction was lower among patients with a preoperative proximal meatal location or chordee, and with correction techniques other than the Mathieu approach. Physician satisfaction decreased with increasing patient age and was lower for patients with preoperative chordee, postoperative complications, or repeat operations. ConclusionsOverall patient and physician satisfaction and clinical outcome scores were relatively high. Patient satisfaction was lower and based on different factors compared to physician satisfaction. Patient satisfaction seems more influenced by aesthetic appearance, but both patients and physicians appear to incorporate clinical characteristics and outcome in their opinion on satisfaction. Patient summaryDifferent factors seem to influence patient and physician satisfaction with hypospadias correction, and there is only low correlation between the two. Therefore, patient satisfaction should be evaluated properly instead of making assumptions based on physician satisfaction or clinical outcome only.