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Hypospadias: conséquences psychosociales, urologiques, sexuelles et reproductives à l’âge adulte

Hypospadias: psychosocial, urological, sexual, and reproductive consequences in adult life.

Andrologievolume 15, pages24–34 (2005) | Download Citation

Resume

L’hypospadias est une anomalie du développement dont la traduction la plus évidente est une position ectopique du méat urétral situé soit sur la face ventrale du gland ou du pénis, soit en position scrotale ou périnéale. La réparation chirurgicale a pour objectifs de permettre une miction en position debout, une pleine sexualité, et d’obtenir une apparence cosmétique de la verge aussi normale que possible. Les résultats d’une revue de la littérature sont présentés.

  1. 1.

    Patients opérés dans l’enfance. Les complications urologiques les plus fréquentes sont les fistules, les diverticules, les sténoses urétrales, et les difficultés mictionnelles. Le risque infectieux n’est pas augmenté. Le développement psychosocial n’est past affecté en général, la maturation et le début de l’éveil sexuels sont normaux. Cependant, ces patients présentent une plus grande difficulté à établir des contacts avec le sexe opposé. A l’âge adulte, les troubles de l’érection et de l’éjaculation sont fréquents.

  2. 2.

    Patients opérés à l’âge adulte. Les résultats urologiques de la chirurgie sont moins bons et les complications plus fréquentes que chez l’enfant. Absence de données sur la sexualité.

  3. 3.

    Patients qui ne seront jamais opérés. Malgré l’absence d’étude spécifique, ces patients ne semblent pas différer de ceux opérés dans l’enfance pour ce qui est des troubles mictionnels, du développement psycho-sexuel et de la sexualité.

  4. 4.

    Capacités reproductives. Les hormones impliquées dans les fonctions testiculaires ne sont en général pas perturbées, que ce soit chez l’enfant ou chez l’adulte. Toutefois, il existe des facteurs cliniques, histologiques, et spermiologiques susceptibles de retentir sur la fertilité. Il n’existe pas à ce jour d’évaluation de la fréquence de l’infertilité dans la population des hommes nés avec un hypospadias et non opérés ou ayant été opérés dans l’enfance.

Abstract

Hypospadias is a developmental abnormality. The most obvious feature is an ectopic urethral meatus situated on the ventral aspect of the glans or the penis, or on the scrotum or perineum. This defect occurs in about 1/250 to 1/300 live births. Surgical repair is designed to allow micturition in a standing position, enable normal sexual function and to give the penis as normal a cosmetic appearance as possible. This malformation and its treatment have repercussions on psychosocial development, urinary and sexual function, and reproduction. The literature distinguishes three populations of patients.

  1. 1.

    Patients who have corrective surgery during childhood. The most frequent urological complications are fistulas, diverticula, urethral stenosis and micturition difficulties. The risk of infection is not increased. Psychosocial development is usually not affected, and maturation and early sexual awareness are normal. However, these patients have greater difficulty in making contact with the opposite sex. In adulthood, problems of erection and ejaculation are frequent.

  2. 2.

    Patients who have corrective surgery in adulthood. The urological results of surgery are less favourables and complications are more frequent than in children. No data about sexual function are available.

  3. 3.

    Patients who do not have surgery. Although there are no specific studies, these patients do not appear to differ from those operated as children in terms of micturition difficulties, psychosexual development and sexual function.

  4. 4.

    Reproductive capacity. There is usually no disorder of the hormones involved in testicular function (gonadotropins, androgens) in either children or adults. However, clinical, histological and spermiological factors may affect fertility.

The frequency of infertility in the population of men who have undergone corrective surgery for hypospadias during childhood has not yet been evaluated.

References

  1. 1.

    AHO M.O., TAMMELA O.K., SOMPPI E.M., TAMMELA T.L.: Sexual and social life of men operated in childhood for hypospadias and phimosis. Eur. Urol., 2000, 37: 95–101.

  2. 2.

    AHO M.O., TAMMELA O.K., TAMMELA T.L.: Aspects of adult satisafaction with the results of surgery for hypospadias performed in childhood. Eur. Urol., 1997, 32: 218–222.

  3. 3.

    AMMINI A.C., SABHERWAL U., MUKHOPADHYAY C., VIJAYARAGHAVAN M., PANDEY J.: Morphogenesis of the human external male genitalia. Pediatr Surg. Int., 1997, 12: 401–406.

  4. 4.

    AVELLAN L.: The development of puberty, the sexual debut and sexual function in hypospadiacs. Scand. J. Plast. Reconstr. Surg., 1976, 10: 29–44.

  5. 5.

    BASKIN L.S.: Hypospadias and urethral development. J. Urol., 2000, 163: 951–956.

  6. 6.

    BASKIN L.: Hypospadias a critical analysis of cosmetic outcomes using photography. Br. J. Urol. Int., 2001, 87: 534–539.

  7. 7.

    BAUER S.B., BULL M.J., RETIK A.B.: Hypospadias: A familial study. J. Urol., 1979, 121: 474–477.

  8. 8.

    BERG R., BERG G., SEVENSSON J. Penile malformation and mental health. A controlled psychiatric study of men operated for hypospadias in childhood. Acta Psychiat. Scand., 1982, 66: 398–416.

  9. 9.

    BERG R., BERG G., EDMAN G., SVENSSON J., ASTRÖM G. Androgens and personality in normal men and men operated for hypospadias in childhood. Acta Psychiat. Scand., 1986, 68: 167–177.

  10. 10.

    BERG R., SVENSSON J., ASTRÖM G.: Social and sexual adjustment of men operated for hypospadias during childhood: a controlled study. J. Urol., 1981, 125: 313–317.

  11. 11.

    BRACKA A.: A long-term view of hypospadias. Br. J. Plast. Surg., 1989, 42: 251–255.

  12. 12.

    BRACKA A.: Sexuality after hypospadias repair. Br. J. Urol. Int., 1999, 83, suppl 3: 29–33.

  13. 13.

    BUSCEMI M.L., SILBER L.M., HANNA M.K.: Intraurethral condylomas acuminata in previous hypospadias repair. Urology, 1985, 26: 398–399.

  14. 14.

    CARIZZA C., ANTIBA A., PALAZZI J., PISTONO C., MORANA F., AALARCON M.: Testicular maldescent and infertility. Andrologia, 1990, 22: 285–288.

  15. 15.

    CONGENITAL MALFORMATIONS WORLDWIDE: A report from the International Clearinghouse for Birth Defects Monitoring Systems. New York. Elsevier Science Publishers, 1991: 113–118.

  16. 16.

    CULP O. S.: Struggles and triumphs with hypospadias and associated anomalies: review of 400 cases. J. Urol., 1966, 96: 339–351.

  17. 17.

    DEVINE C.J., FRANZ J.P., HORTON C.E. Evaluation and treatment of patients with failed hypospadias repair. J. Urol., 1978, 119: 223–226.

  18. 18.

    DEVINE C.J., GONZALES-SERVA L., STECKER J.F., DEVINE P.C., HORTON C.E.: Utricular configuration in hypospadias and intersex. J. Urol., 1980, 123: 407–411.

  19. 19.

    DODD, M., LAWSON P., HAYMAN J.: Squamous cell carcinoma of the distal urethra in a patient with congenital hypospadias. Pathology, 1996, 28: 96–97.

  20. 20.

    EBERLE J., UBERREITER S., RADMAYR C., JANETSCHEK G., MARBERGER H., BARTSCH G.: Posterior hypospadias: long-term follow up after reconstructive surgery in the male direction. J. Urol., 1993, 150: 1474–1477.

  21. 21.

    FALLON B., DEVINE C.J., Jr., HORTON C.E.: Congenital anomalies associated with hypospadias. J. Urol., 1976, 116: 585–586.

  22. 22.

    FARKAS L.G., HYNIE J.: Aftereffects of hypospadias repair in childhood. Postgrad. Med., 1970, 47: 103–105.

  23. 23.

    FEYAERTS A., FOREST M.G., MOREL Y. et al.: Endocrine screening in 32 consecutive patients with hypospadias. J. Urol., 2002, 168: 720–725.

  24. 24.

    FICHTNER J., FILIP S.D., MOTTRIE A.M., VOGES G.E., HOHENFELLNER R.: Analysis of meatal location in 500 men: wide variation questions need for meatal advencement in all pediatric anterior hypospadias cases. J. Urol., 1995, 154: 833–834.

  25. 25.

    FINKELSTEIN L.H., BLASTEIN L.M.: Epilation of hair-bearing urethral garfts using the neodymium: Yag surgical laser. J. Urol., 1991, 146: 840–842.

  26. 26.

    FLYNN J.T., JOHNSTON S.R., BLANDY J.P.: Late sequelae of hypospadias repair. Br. J. Urol., 1980, 52: 555–559.

  27. 27.

    HENSLE T.W., TENNENBAUM S.Y., REILEY E.A., POLLARD J.: Hypospadias repair in adults: adventures and misadventures. J. Urol., 2001, 165: 77–79.

  28. 28.

    HOLLAND A.J., SMITH G.H., ROSS F.I., CASS D.T. HOSE: an objective scoring system for evaluating the results of hypospadias surgery. Br. J. Urol. Int., 2001, 88: 255–258.

  29. 29.

    JUGENBURG I., KIPIKASA A.: Fertility in patients with hypospadias. Acta Chir. Plast., 1988, 30: 86–93.

  30. 30.

    KENAWI M.M.: Sexual function of hypospadiacs. Br. J. Urol., 1976, 47: 883–890.

  31. 31.

    KENNEDY P.A. Jr.: Hypospadias: a twenty year review of 489 cases. J. Urol., 1961, 85: 814–817.

  32. 32.

    KOJIMA Y., HAYASHI Y., MIZUNO K., MOGAMI M., SASAKI S., KOHRI K.: Spermatogenesis, fertility and sexual behavior in a hypospadiac mouse model. J. Urol. 2002, 167: 1532–1537.

  33. 33.

    KHURI F.J., HARDY B.E., CHURCHILL B.M.: Urologic anomalies associatied with hypospadias. Urol. Clin. North Am., 1981, 8: 565–571.

  34. 34.

    KULKARNI B.K., OAK S.N., PATEL M.P., MERCHANT S., BORWANKAR S.S. Developmental anomalies associated with hypospadias. J. Postgrad. Med., 1991, 37: 140–143.

  35. 35.

    LI L.C., ZHANG X., ZHOU S.W. et al.: Experience with repair of hypospadias using bladder mucosa in adolescents and adults. J. Urol., 1995, 153: 1117–1119.

  36. 36.

    MALYON A.D., BOORMAN J.G., BOWLEY N.: Urinary flow rates in hypospadias. Br. J. Plast. Surg., 1997, 50: 530–535.

  37. 37.

    MIEUSSET R., BUJAN L., MASSAT G., MANSAT A., PONTONNIER F.: Clinical and biological characteristics of infertile men with a history of cryptorchidism. Hum. Reprod., 1995, 10: 613–619.

  38. 38.

    MILLER M.A., GRANT D.B.: Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair. Br. J. Urol., 1997, 80: 485–488.

  39. 39.

    MONDAINI N., PONCHIETTI R., BONFÈ M. et al.: Hypospadias: incidence and effects on psychosexual development as evaluated with the Minnesota Multiphasic Personality Inventory Test in a sample of 11,649 young italian men. Urol. Int., 2002, 68: 81–85.

  40. 40.

    MOUDOUNI S., TAZI K., NOURI M., KOUTANI A., HACHIMI M., LAKRISSA A. L’hypospadias de l’adulte. Prog. Urol., 2001, 11: 667–669.

  41. 41.

    MUREAU M.A., SLIJPER F.M., NIJMAN R.J., VAN DER MEULEN J.C., VERHULST F.C., SLOB A.K.: Psychosexual adjustment of children and adolescents after different types of hypospadias surgery: a norm-related study. J. Urol., 1995, 154: 1902–1907.

  42. 42.

    MUREAU M.A., SLIJPER F.M., SLOB A.K., VERHULST F.C.: Genital perception of children, adolescents and adults operated on for hypospadias surgery: a comparative study. J. Sex. Res., 1995, 32: 289–298.

  43. 43.

    MUREAU M.A., SLIJPER F.M., SLOB A.K., VERHULST F.C.: Psychosocial functionning of children, adolescents, and adults following hypospadias surgery: a comparative study. J. Pediatr. Psychol., 1997, 22: 371–387.

  44. 44.

    MUREAU M.A., SLIJPER F.M., SLOB A.K., VERHULST F.C., NIJMAN R.J.: Satisfaction with penile appearence after hypospadias surgery: the patient and surgeon view. J. Urol., 1996, 155: 703–706.

  45. 45.

    MUREAU M.A., SLIJPER F.M., VAN DER MEULEN J.C., VERHULST F.C., SLOB A.K.: Psychosexual adjustment of men who underwent hypospadias repair: norm-related study. J. Urol., 1995, 154: 1351–1355.

  46. 46.

    NEAL D.E., ORIHUELA E., CROTTY K., LAHAYE M., DAVIDSON S., MOTAMEDI M.: Laser ablation of uretral hair. Lasers Surg. Med., 1999, 24: 261–263.

  47. 47.

    PAULOZZI L.J.: International trends in rates of hypospadias and cryptorchidism. Environ. Health Perspect., 1999, 107: 297–302.

  48. 48.

    POMARA G.S., POMARA F., TRAVAGLINI F., MARASA L., SELLI C.: Verrucous scrotal carcinoma in a patient with hypospadias: is there a possible association? Urology, 2003, 61: 224–225.

  49. 49.

    ROSS J.F., FARMER A.W., LINDSAY W.K.: Hypospadias: A review of 230 cases. Plast. Reconstr. Surg., 1959, 24: 357–368.

  50. 50.

    SADLER T.W.: Langman’s embryology. 7th ed. Baltimore, Williams and Wilkins, 1995: 298–302.

  51. 51.

    SANDBERG D.E., MEYER-BAHLBURG H.F., ARANOFF G.S., SCONZO J.M., HENSLE T.W.: Boys with hypospadias: a survey of behavioral difficulties. J. Pediatr. Psychol., 1989, 14: 491–514.

  52. 52.

    SANDBERG D.E., MEYER-BAHLBURG H.F., HENSLE T.W., LEVITT S.B., KOGAN S.J., REDA E.F.: Psychosocial adaptation of middle childhood boys with hypospadias after genital surgery. J. Pediatr. Psychol., 2001, 26: 465–475.

  53. 53.

    SANTAMARIA OSSORIO J.I., SANJUAN RODRIGUEZ S.: Hipospadias: resultados y repercusiones psicologicas. Cir. Pediatr., 2002, 15: 3–7.

  54. 54.

    SECREST C.L., JORDAN G.H., WINSLOW B.H. et al.: Repair of the complications of hypospadias surgery. J. Urol., 1993, 150: 1415–1418.

  55. 55.

    SENKUL T., KARADEMIR I., ISERI C., ERDEN D., BAYKAL K., ADAYENER C.: Hypospadias in adults. Urology. 2002, 60: 1059–1062.

  56. 56.

    SHIMA H., IKOMA F., TERAKAWA T. et al.: Developmental anomalies associated with hypospadias. J. Urol., 1979, 122: 619–621.

  57. 57.

    SIDES D., GOLDSTEIN R.B., BASKIN L., KLEINER B.C.: Prenatal diagnosis of hypospadias. J. Ultrasound Med., 1996, 15: 741–745.

  58. 58.

    SINISI A.A., D’APUZZO A., PASQUALI D. et al.: Antisperm antibodies in preburtal boys treated with chemotherapy for malignant or non malignant diseases and in boys with genital tract abnormalities. Int. J. Androl., 1997, 20: 23–28.

  59. 59.

    SMYTH B.T., FORSYTHE I.W.: Hypospadias and associated anomalies of the genitourinary tract. J. Urol., 1959, 82: 109–114.

  60. 60.

    SOMMERLAD B.C.: A long term follow-up of hypospadias patients. Br. J. Plast. Surg., 1975, 28: 324–330.

  61. 61.

    SVENSSON J., BERG R.: Micturition studies and sexual function in operated hypospadiacs. Br J Urol., 1983, 55: 422–426.

  62. 62.

    SWEET R.A., SCHROTT H.G., KURLAND R., CULP O.S.: Study of the incidence of hypospadias in Rochester, Minnesota, 1940–1970, and a case-control comparison of possible etiologic factors. Mayo Clin. Proc., 1974, 49: 52–58.

  63. 63.

    THONNEAU P.F., GANDIA P., MIEUSSET R.: Cryptorchidism: incidence, risk factors, and potential role of environment; an update. J. Androl., 2003, 24: 155–162.

  64. 64.

    UNITED KINGDOM TESTICULAR CANCER STUDY GROUP. Aetiology of testicular cancer: Association with congenital abnormalities, age at puberty, infertility, and exercise. Br. Med. J., 1994, 308: 1393–1399.

  65. 65.

    UYGUR M.C., ERSOY E., EROL D.: Analysis of meatal location in 1,244 healthy men. Pediatr Surg. Int., 1999, 15: 119–120.

  66. 66.

    VAN DER PUTE S.C.: Normal and abnormal development of the anorectum. J. Pediatr. Surg., 1986, 21: 434–440.

  67. 67.

    VAN DER WERFF J.F., NIEVELSTEIN R.A., BRANDS E., LUIJSTERBURG A.J., VERMEIJ-KEERS C.: Normal development of the male anterior urethra. Teratology, 2000, 61: 172–183.

  68. 68.

    VERMEIJ-KEERS C., HARTIG N.G., VAN DER WERFF J.F.: Embryonic development of the ventral body wall and its congenital malformations. Semin. Pediatr. Surg., 1996, 5: 82–89.

  69. 69.

    VIVILLE C.: L’hypospadias de l’adulte: à propos de 15 observations. Prog. Urol., 1993, 3: 415–418.

  70. 70.

    WU W.H., CHUANG J.H., TING Y.C., LEE S.H., HSIEH C.S.: Developmental anomalies and disabilities associated with hypospadias. J. Urol., 2002, 168: 229–232.

  71. 71.

    WEHNERT J.: Zur Korrelation zwischen Hypospadie und weiteren angeborenen Missbildungen. Z. Urol. Nephrol., 1974, 67: 857–860.

  72. 72.

    WILLIS C., BRANNAN W., OCHSNER M.: Hypospadias and associated anomalies. South Med. J., 1967, 60: 969–970.

  73. 73.

    ZAONTZ M.R., PACKER M.G.: Abnormalities of the external genitalia. Pediatr. Clin. North. Am., 1997, 44: 1267–1297.

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  1. Recherche en Fertilité Humaine, EA 36 94, Service Urologie-Andrologie, Hôpital Paule de Viguier, TSA 70034, 31059, Toulouse cedex 9

    • Roger Mieusset

  2. Service d’Urologie-Andrologie, Hôpital Rangueil, Toulouse, France

    • Michel Soulie

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Correspondence to Roger Mieusset.

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Mots clés

  • hypospadias
  • adulte
  • complications urologiques
  • développement psychosocial
  • sexualité reproduction

Key words

  • hypospadias
  • adult
  • urological consequences
  • psychosocial functioning
  • sexuality
  • reproduction

Basic and Clinical Andrology

ISSN: 2051-4190