Long-term Follow-up And Comprehensive-Assessment Of Children With Hypospadias: Psychosocial And Psychosexual Factors

Objectives：The aim of this study was to assess the long-term outcome of hypospadias surgery inminors, to understand their urinary function, gender trends, penis appearance satisfaction,mental development and social psychological status, to explore psychological andbehavioral characteristics in different ages of children, so as to provide more evidence for acomprehensive correction of hypospadias.Materials and methods：From2000through2013， patients with hypospadias and undergone surgicalcorrection in this institution were enrolled．The age at research was between2to17yearsand the follow-up duration was at least half year after the final surgery. Self-constructquestionnaire, Raven’s Standard Progressive Matrices (SPM), Urinary flow ratemeasurement, Achenlach Children Behavior Checklist (CBCL), Children’s temperamentscale (CTTS， CPTS， CSTS), Gender identity questionnaire and Penile appearanceself-assessment questionnaire were applied for outpatient reexamination mainly throughthe interview questionnaire, phone contact was as supplement. The survey results werestatistically analyzed.Results：Of513patients to be enrolled for investigation,160cases (31.2%) were responded,and among which66(41.3%) received interview questionnaire,62in66cases (93.9%)completed the questionnaire. The patient age at follow-up was between2to17years old.The average follow-up duration was3.76±2.78years (from0.5years to11years), and theaverage age of primary surgery was3.89±2.66years (from1years to11years).Of62patients，29(46.8%) were distal，33(53.2%) were proximal hypospadias.Regarding the overall evaluation of penile appearance，43patients (68.8%) were “completely satisfied” and13patients (30.2%) were“generally satisfied”. Proximal typehad high complications compared to distal type (22.6%VS11.2%), there was nosignificant difference in satisfaction with penile appearance between them (11.58±3.74VS11.81±2.55, P﹥0.05).In regard to the overall evaluation of urinary function,17patients(27.4%)were“completely satisfied”,33patients(53.2%) were “generally satisfied”,12patients(19.4%) were “dissatisfied”. There were significant differences in maximum flow rate,average flow rate, voiding time between proximal and distal hypospadias (P﹤0.05).CBCL social capabilities scale survey data revealed that most pediatric patients hadfew hobbies, few patients participated in group activities, and their intelligence were at amedium level (IQ:64%±29%). Positive rates of behavioral problems were lower inpatients with high levels of parental education than those with low levels of parentaleducation (χ2=7.364, P﹤0.05).32.6%of the patients showed performance with unstablemental status (slowness:21.7%; troublesome:10.9%).The majority of patients showed their behavior consistent with the gender.85%patients did not want to mention their genitals. There were no significant differences ingender tendency between the proximal and distal hypospadias(60.3±5.78VS61.84±5.3,t=1.2446, P>0.05). There were significant correlation between temperament type,emotional disorders and penile appearance satisfaction, postoperative complications.Urination satisfaction was positively related to the penile appearance satisfaction(P<0.01).Postoperative complications was associated with urination satisfaction(P<0.01).Postoperative complications affected most significantly the temperament type of patients.Conclusions:1、 Most hypospadias patients have good psychosocial and psychological status,some patients have problems in the urinary function, emotional stability.2、 Most hypospadias patients deliberately avoid mentioning the appearance oftheir penis and a portion of patients have poor social adaptation ability, introvertedpersonality.3、 There were significant correlation between penile appearance, postoperativecomplications and psychosocial status. The better looking of the penis appearance and thefewer postoperative complications, the better the psychological status of patients is.4、 The type of hypospadias and the age at initial surgery may affect the psychological status of patients.5、 Urination satisfaction is correlated significantly with the penile appearancesatisfaction, and the urination dissatisfaction is associated with the postoperativecomplications.