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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.

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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.

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Correspondence to Roger Mieusset.

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