Bulbospongiosus Muscle Reconstruction in Proximal Hypospadias: Post pubertal Function and Patient Satisfaction.

Introduction: Ejaculatory disturbances are prevalent in pubertal studies following childhood proximal hypospadias repair. Bulbospongiosus muscle (BSM) is described as vital for evacuation of the last drop, erections and ejectile ejaculations. Our intention was to assess adolescent outcomes following reconstruction of split BSM observed in proximal hypospadias.

Method: Hypospadias was defined as proximal when the bifurcation of the spongiosum was proximal to the anterior end of the pubic bones, and severe when ventral curvature (VC) was >30° after degloving. In these, between January 2003 and December 2009, the bulbospongiosus muscle was apposed in the midline around the bulbar urethra and the urethral plate was transected and grafted for 2-stage surgery. Annual post pubertal assessments, from 12-years of age, included the Hypospadias Objective Scoring Evaluation (HOSE) by the clinician, and Penile Perception Score (PPS) and urination and ejaculation descriptions provided solely by the patient.

Results: 22 fulfilled the inclusion criteria of having pubertal assessments. The mean age at last consultation was 17.2 years (SD 1.3 years). The meatus at follow-up was glanular in 15, coronal in 5 and distal shaft in 2. 95.4% described strong urinary streams and no dribbling, and 94.4% described ejectile ejaculations. Median HOSE score was 14p (12p-16p) and PPS 16p (14p-18p).

Conclusion: Data offered by patients with proximal hypospadias following bulbospongiosus muscle reconstruction around the bulbar urethra, indicates a non-dribbling urinary steam, erections and ejectile ejaculations that meet with strong patient perception of satisfactory function and genital aesthetics. A suboptimal meatal site was not of major relevance.

Level of evidence: IV.