Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey

Abstract

Objective: Hypospadias is usually treated in childhood. Therefore, the natural history of untreated mild hypospadias is unknown. We hypothesized that men with untreated hypospadias, especially mild, do not have adverse outcomes.

Materials: Facebook was used to advertise an electronic survey to men older than 18 years. Men with untreated hypospadias identified themselves and indicated the severity of hypospadias with a series of questions. Outcomes included: Sexual Health Inventory for Men (SHIM), penile curvature and difficulty with intercourse, International Prostate Symptom Score (IPSS), Penile Perception Score (PPS), psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module.

Results: 736 men completed self-anatomy questions and 52 (7.1%) self-identified with untreated hypospadias. Untreated hypospadias participants reported worse SHIM (p < 0.001) and IPSS scores (p = 0.05), more ventral penile curvature (p = 0.003) and resulting difficulty with intercourse (p < 0.001), worse satisfaction with meatus (p = 0.011) and penile curvature (p = 0.048), and more sitting to urinate (p = 0.07). When stratified by mild and severe hypospadias, severe hypospadias was associated with more adverse outcomes than mild hypospadias.

Conclusion: Men with untreated hypospadias reported worse outcomes compared with non-hypospadiac men. Mild untreated hypospadias had fewer adverse outcomes than severe hypospadias. Research is needed to determine if treatment of childhood hypospadias improves outcomes in adults, especially for mild hypospadias.

Keywords: Chordee; Hypospadias; Penile curvature.

Figure 1

Sketches used for participants to report anatomy. Question 1: Which of the above sketches is most like where your urethral opening is located? The urethral opening is where urine exits when you urinate. Choose the best answer (A–F). Question 2: Which of the above sketches is most like the appearance of your penis and foreskin? Choose the best answer (A–E). Question 3: Which of the above sketches is most like the curvature of your penis when you have an erection (penis gets hard)? We are only asking about up/down curvature not left/right curvature. Choose the best answer (1–5).