A Follow-up Study On Penis Appearance And Urodynamics Of Children And Adolescents Who Underwent Hypospadias

Background and ObjectsHypospadias is one of the most common malformations of the urogenital system in children.Although the surgical treatment of hypospadias has made great progress,the long-term results of hypospadias are still not satisfactory from the perspective of physicians,patients or parents.At present,the long-term follow-up study data of children and adolescents are very limited,especially in the aspect of penis appearance and urination function.In this study,long-term follow-up was conducted of children and adolescents who underwent hypospadias,and the penis appearance and urination status of the patients were evaluated by questionnaire,and the urination function of the patients was objectively evaluated by urodynamic examination.To analyze the penis appearance,urination function satisfaction and related influencing factors of postoperative patients with hypospadias,and to discuss the correlation between them and long-term effects,so as to provide a basis for further improvement of the treatment of hypospadias.MethodsPatients with hypospadias who received treatment in the pediatric surgery department of the hospital from November 2001 to November 2013 were followed up by interview and telephone communication.Contact patients 5 years or older who are under the age of 18 years after surgery for conformance to hypospadias.After obtaining the consent of the patients and their families,the patients who came to the outpatient department for reexamination were examined by urodynamic examination and questionnaire survey.For the patients who did not come to the outpatient department for reexamination,the postoperative situation of the patients was understood through telephone communication,and the results were statistically analyzed.ResultsA total of 158 patients were contacted,and 63 patients completed all valid questionnaires,and 39 patients completed urodynamic examination.Patients ranged from 6 to 18 years old,with an average age of 10.8 years.According to the location of urethral orifice,there were 20 cases of penis head type(31.8%),31 cases of penis body type(49.2%),11 cases of penis scrotal type(17.5%),and 1 case of perineal type(1.6%).There were 37 cases in the distal type group(penis head type,coronal sulcus type,anterior penis type)and 26 cases in the proximal type group(posterior penis type,penis scrotal type,perineal type).82.5% of the patients were satisfied with the overall effect of the surgery,and 17.5% were not satisfied with the overall effect.12.7%of the patients had basic knowledge of hypospadias,61.9% knew little about it,and 25.4% did not.In the overall penis appearance satisfaction survey,81.0% of the patients were satisfied with the appearance of the penis,and 19.0% of the patients were not satisfied with the appearance of the penis,mainly due to the position of the urethral orifice and short penis.By comparison,the "proximal type group" had a higher proportion of postoperative complications than the "distal type group"(57.7%vs18.9%,P< 0.05).The results of correlation analysis showed that the less the number of operations,the higher the penis appearance satisfaction(r=-3.14,P< 0.05).The higher the satisfaction of penis appearance,the higher the overall postoperative effect evaluation(r=0.312,P < 0.05).In the survey on the satisfaction of urination function,85.7% of the patients were satisfied with the urination function,and 14.3% were not satisfied with the urination function,mainly due to weak steam of urine,irregular urine lines and trickle micturition.Through comparison,it was found that the "proximal type group" had a higher proportion of dissatisfaction with urination function than the "distal type group"(26.9% vs 5.4%,P < 0.05).According to the severity classification,all patients who have had urodynamics were divided into hypospadias(I °,II °,III °)groups,three groups in the maximum urinary flow rate,average urine flow rate,micturition time,time to peak,residual urine volume,maximum detrusor systolic and blood pressure have significant difference(p < 0.05).There was no difference in urine output(p > 0.05).The results of the correlation analysis showed that the earlier the age of the first operation(r=-0.121,p < 0.05)and the earlier the age of the last operation(r=-0.163,p < 0.05),the higher the satisfaction with urination function.There was a positive correlation between urinary satisfaction and overall postoperative satisfaction(r=0.196,p < 0.05).ConclusionsThe satisfaction of the overall penis appearance of children and adolescents after hypospadias surgery is high,and the correlation analysis shows that the appearance of the penis has a significant effect on the mid-long-term results;most of the patients after hypospadias surgery have good urination function,and urodynamics can be used as an objective index to evaluate the urinary function of patients.