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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.

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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Article  Google Scholar 

  5. 5.

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

    PubMed  Article  CAS  Google Scholar 

  6. 6.

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

    CAS  Google Scholar 

  7. 7.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  11. 11.

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

    PubMed  Article  CAS  Google Scholar 

  12. 12.

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

    Google Scholar 

  13. 13.

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

    PubMed  Article  CAS  Google Scholar 

  14. 14.

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

    PubMed  CAS  Article  Google Scholar 

  15. 15.

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

    Google Scholar 

  16. 16.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  21. 21.

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

    PubMed  CAS  Google Scholar 

  22. 22.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  26. 26.

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

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    CAS  Google Scholar 

  29. 29.

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

    PubMed  CAS  Google Scholar 

  30. 30.

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

    Article  Google Scholar 

  31. 31.

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

    PubMed  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  33. 33.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

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

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  47. 47.

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

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  49. 49.

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

    Article  CAS  Google Scholar 

  50. 50.

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

    Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  53. 53.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  55. 55.

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

    PubMed  Article  Google Scholar 

  56. 56.

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

    PubMed  CAS  Google Scholar 

  57. 57.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  59. 59.

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

    PubMed  CAS  Google Scholar 

  60. 60.

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

    PubMed  Article  CAS  Google Scholar 

  61. 61.

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

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  66. 66.

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

    Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  69. 69.

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

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  71. 71.

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

    PubMed  CAS  Google Scholar 

  72. 72.

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

    PubMed  CAS  Google Scholar 

  73. 73.

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

    PubMed  Article  CAS  Google Scholar 

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Mieusset, R., Soulie, M. Hypospadias: conséquences psychosociales, urologiques, sexuelles et reproductives à l’âge adulte. Androl. 15, 24–34 (2005). https://doi.org/10.1007/BF03035187

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Mots clés

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

Key words

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