Annaleena Anttila

Objective: To present data on sexual function in post‐pubertal patients after hypospadias surgery in childhood.Patients and Methods: We assessed 169 (96 distal, 20 midshaft, 53 proximal) patients with hypospadias born between 1991 and 2003, who underwent surgery before the age of 5 years. At a median (interquartile range) follow‐up age of 16.2 (16.0–16.8) years, participants completed a pre‐mailed sexual function questionnaire, including the Erection Hardness Score (EHS) during the last control visit. Dorsal Nesbit‐like plication was used for curvature correction in 62 patients. Previously published normative data served as controls.Results: All patients reported having erections; 73% achieved EHS 4 (completely hard and fully rigid). In patients with distal hypospadias, EHS 4 was reported in 68% of cases, 85% of midshaft and 79% of proximal cases. Among those with and without curvature correction by Nesbit‐like plication, EHS 4 was reported in 72% and 74%, respectively. The proportion reporting EHS 4 exceeded that of published controls (P < 0.01). Penile straightness during erection was reported by 95% of patients overall, with no significant differences across hypospadias subtypes or curvature correction status. Only one patient reported pain during ejaculation; none reported pain during erection. Ejaculation was reported by 95% of participants.Conclusion: Adolescents who underwent early hypospadias repair reported favourable sexual function outcomes, including high rates of erectile rigidity and ejaculatory function. Neither hypospadias severity nor the need for curvature correction affected these outcomes. These findings support the long‐term sexual well‐being of patients undergoing surgery for hypospadias in childhood.

Objective: To assess the cumulative rates of re‐operations after hypospadias repair and evaluate long‐term surgical outcomes at a tertiary paediatric urology centre. Patients and Methods: Retrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan–Meier methods were used to evaluate the re‐operation data. Results: The median age at primary surgery was 1.3 years, with a median follow‐up of 14.4 years. The overall re‐operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re‐operation was correlated with hypospadias severity, with 5‐ and 15‐year re‐operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards. Conclusion: There is a significant risk of unplanned re‐operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow‐up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.