This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Sep 2021This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001924AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Adolescent and Young Adult Urogenital Outcome following Childhood Hypospadias Repair There are many conditions that come to mind when one thinks of pediatric urology. Among them are nocturnal enuresis, urinary tract infection, vesicoureteral reflux, bladder exstrophy, cryptorchidism, hydronephrosis and of course all of the issues related to circumcision. Hypospadias, however, is arguably the 1 condition that helps define modern pediatric urology as a subspecialty. Coined by Duckett in 1995, “hypospadiology” described the treatment of primary hypospadias as a humbling process that confounds even the most experienced and skillful surgeon and as much a blend of art and science rather than an algorithm with easily reproduced results.1 The decades of progress and in some cases superb outcomes have not, however, obscured the reality that we still have many gaps in our understanding. Rigorous comparison of different techniques and even the categorization of the degree of severity remain elusive due to a lack of standardization. Long-term urinary and sexual function are under evaluated. In an effort to expand our understanding, Tack et al (page 734) from Belgium and Austria report on data drawn from Ghent and Vienna.2 They focused on the long-term psychosexual, urological and reproductive outcomes in a group of adolescent and young adult men with hypospadias. Using a cross-sectional approach with 193 patients and 50 case controls, the median age of first repair was 1.5 years old and followup was at 18.14 years of age. Nearly 40% had at least 1 revision surgery. About 53% had poorer urinary and sexual function. Proximal hypospadias and re-operations were particularly associated. These findings reinforce the current awareness of limitations of treatment of these patients.3 There was a sharp variation between how patients and physicians assessed genital appearance. The highest agreement was in the more objective findings of axis of penile erection with the lowest being overall appearance. This interesting observation suggests that treating urologists might need to reconsider efforts at cosmetic perfection. If the term “hypospadiology” marked the first era of hypospadias therapy, studies that further our understanding of the long-term effects may usher in the next era.