[Hypospadias: A Long-Term Problem?]

Abstract

Abstract: The transition from pediatric to adult care poses particular challenges for patients with hypospadias. Not infrequently, patients who underwent corrective surgery in early childhood have little or no knowledge of the initial severity or phenotype of their hypospadias or of the surgical technique that was used. Sometimes they are unable to name the center or the surgeon or to recall the number of prior procedures, and sometimes the only information available is that "some" form of penile surgery was performed.The spectrum of problems occurring in adolescence and adulthood is broad, and many patients report more than one complaint. We encounter urethral strictures of varying complexity, a meatus that is not or no longer in glanular location, urethrocutaneous fistulae, post-void dribbling, diverticula, spraying of the urinary stream, residual or recurrent penile curvature, cutaneous scarring, insufficient ventral penile skin, recurrent urinary tract infections, lichen sclerosus, and other sequelae.Therapeutic planning must take into account the patient's expectations and concerns, while also realistically prioritizing individual treatment goals. In many cases, more than one reconstructive procedure is required to achieve the desired outcome.Within the transition process, the primary objectives should be to reduce patient anxiety, address concerns with empathy, and maintain a comprehensive armamentarium of reconstructive options in order to provide individualized treatment strategies.