Comparison of preputioplasty and circumcision in distal hypospadias correction: long-term follow-up

Summary Objective A normal penile cosmesis is an important goal in distal hypospadias repair. Depending on cultural standards, repairs are combined with a preputioplasty or circumcision to attain a ‘normal’ penile appearance. Although short-term complication rates of preputioplasty are available, data on long-term outcomes are scarce. Therefore, this study assessed long-term functional and cosmetic outcomes of distal hypospadias repair with either a preputioplasty or a circumcision. Patients and methods Eligible for inclusion were patients with distal hypospadias operated in childhood between 1987 and 1993. Complications and reasons for secondary circumcision were extracted from the medical charts. Participants completed a questionnaire including the International Index of Erectile Function (IIEF-15), the International Prostate Symptom score (IPSS), and additional non-validated questions. Penile cosmesis was judged with the Penile Perception Score (PPS), stretched penile length was measured, and uroflowmetry was performed. Results Of the 86 eligible and traceable patients, 40 (47%) participated; of them, 27 had a preputioplasty and 13 a circumcision. Six patients underwent a secondary circumcision due to a preputial defect ( n  = 2), unsatisfactory cosmetic result ( n  = 2), religious reason ( n  = 1), or phimosis ( n  = 1). Complication rates were similar in both the groups. Long-term outcomes in the preputioplasty and circumcision group were comparable regarding cosmetic, sexual, and micturition outcomes. Conclusions Distal hypospadias correction combined with preputioplasty had complication rates similar to those of hypospadias repair with circumcision. In these patients, preputioplasty had a failure rate of 22%. In both the groups, long-term outcomes of urinary function, sexual function, and cosmesis were good. Preputioplasty n  = 27 Circumcision n  = 13 P -value Median [IQR] n Median [IQR] n MWU Age at follow-up (years) a 20.0 [19.3–22.6] – 19.4 [19.3–20.0] – 0.29 Age at the first operation (years) 1.3 [1.0–3.9] – 0.9 [0.9–1.8] – 0.17 Number of surgeries 2.0 [1.0–3.0] – 2.0 [1.0–2.5] – 0.78 Time to secondary circumcision (years) n  = 6 1.5 [0.8–2.6] – – – – Age at secondary circumcision (years) n  = 6 5.6 [4.1–7.9] – – – – Complications % % χ 2 Complication rate total (%) – 67 – 53 0.34 Complication rate without prepuce-related events (%) – 48 – 46 0.48 Preputioplasty n = 21 Circumcision n = 19 P -value Sexuality Median [IQR] n Median [IQR] N MWU IIEF-15: Erectile function (1–30) 28.0 [14.0–30.0] 19 27.5 [9.5–30.0] 16 0.68 Cosmesis n n PPS: general cosmetic score  (very) satisfied – 15/21 – 19/19  (very) dissatisfied – 6/21 – 0/19 Micturition Median [IQR] n Median [IQR] n χ 2 IPSS (total score) 0.08  ≤7 – 18/19 – 12/17  8–19 – 1/19 – 5/17 IPSS 8 micturition satisfaction  (very) satisfied – 17/19 – 9/17  (very) dissatisfied – 2/19 – 8/17 Uroflowmetry MWU  Qmax (ml/s) 25.5 [17.5–37.0] 20 27.4 [19.2–36.7] 19 0.81 IQR, interquartile range; MWU, Mann–Whitney U-test; χ 2 , : Chi-squared test; IIEF, International Index of Erectile Function; PPS, Penile Perception Score; IPSS, International Prostate Symptom Score; Qmax, maximum flow rate. Analysis by treatment-received analysis. a Follow-up since the first operation until visit at outpatient clinic for assessment.