Redo surgery improves sexual function in patients with sequelae of failed hypospadias repair

Abstract

ABSTRACT Introduction Despite major improvements in management of congenital abnormalities of male external genitalia, non-pediatric urologists still encounter late complications of failed hypospadias repair. Such patients represent a complex group burdened with lower urinary tract symptoms, subfertility and sexual dysfunction. Psychological problems related to appearance of external genitalia are also common. It is currently unknown whether redo surgery improves sexual well-being in adults with sequelae of failed hypospadias repair. Objective To evaluate improvement in sexual function in patients with late complications of hypospadias repair. Methods We performed an analysis of symptoms related to sexual dysfunction in 112 patients with late complications of hypospadias repair who were admitted to our department for redo surgery. Average age of patients at admission was 32.1 years (min-max: 18-62). All patients consented to interview, completion of questionnaires, endocrine evaluation and penile doppler ultrasound when indicated. We compared prevalence of specific sexual symptoms before and after redo surgery using McNemar's test. Results Prevalence of erectile dysfunction following redo surgery decreased from 40.2% to 23.2% (p < 0.0001). Prevalence of low libido decreased from 59.8% to 30.3% (p < 0.0001). Asthenic ejaculation also became less frequent; initially it was present in 63.4% patients, and after surgery it was present only in 24.1% (p < 0.0001). Incidence of painful ejaculation decreased from 10.7% to 0.9% (p = 0.0026). Redo surgery didn't have positive or negative impact on premature ejaculation, delayed ejaculation, anejaculation and orgasmic dysfunction. Conclusion Redo surgery for complications of hypospadias repair seems to positively impact libido and erectile function, probably through improvement of body image and alleviation of psychogenic factors for erectile dysfunction. However, most ejaculation-related disorders, except asthenic ejaculation and painful ejaculation, remain unaffected. Disclosure Work supported by industry: no.