Adolescent Satisfaction and Decisional Regret After Hypospadias Repair in Early Childhood

Half of patients required unplanned reoperations; only 2.9% of adolescents later reported decisional regret about early surgery.

Journal: Urology | Published: 2026-03-12 | Type: Journal Article | PMID: 41831699 Authors: Taskinen S, Anttila A, Pakkasjärvi N (Department of Paediatric Surgery, Helsinki University Hospital, Finland) Funding/COI: Funding not listed; authors declare no competing financial interests.

Summary

176 Finnish adolescents who had hypospadias repaired in infancy (median age at surgery: 1.4 years) completed a validated satisfaction questionnaire at median age 16.3 years. Despite a 51% unplanned reoperation rate, the vast majority were satisfied — though dissatisfaction with penile length and overall appearance was significantly higher than in age-matched controls. Decisional regret was rare at 2.9%.

Claims

• 64% response rate (176 of ~275 patients); 101 distal, 20 midshaft, 55 proximal hypospadias
• 51% had undergone at least one unplanned reoperation before follow-up
• Dissatisfaction with penile length: 18.6% of patients vs. 0% of controls (P < .01)
• Dissatisfaction with overall penile appearance: 11.8% vs. 1.6% (P = .03)
• Dissatisfaction with meatal location, glans shape, skin, and straightness did not differ significantly from controls
• Penile Perception Score (PPS) scores were generally higher (better) after distal vs. proximal repair
• Dissatisfaction with penile length was more common after Nesbit corporoplasty (26% vs. 12%, P = .03)
• 89.8% considered the timing of their childhood surgery appropriate
• Decisional regret: 2.9%

Study Quality

This is a retrospective questionnaire study with prospective data collection at a scheduled final follow-up visit — a reasonable design for long-term patient-reported outcome research. The Penile Perception Score is a validated instrument, which is the right tool for this question. The ~15-year follow-up interval is genuinely long for a surgical outcomes study in this population. Sample size of 176 is substantial for a relatively rare condition, and stratification by severity subtype (distal/midshaft/proximal) allows meaningful subgroup comparison.

The critical methodological weakness is the control comparison: normative PPS data were pulled from previously published literature, not a concurrently recruited comparison group. This introduces unknown confounders — different recruitment years, different countries, different social contexts. The 36% non-response rate also warrants scrutiny; patients most dissatisfied with outcomes may be systematically more or less likely to attend a final follow-up visit and complete a questionnaire.

Red Flags

• Control data sourced from published normative material, not prospectively recruited controls — the two groups are not directly comparable
• 36% non-response; direction of response bias unknown but plausible (both over- and under-reporting dissatisfaction are possible)
• Single center (Helsinki) limits generalizability; outcomes likely reflect one high-volume team's technique, not population-level surgical practice
• Funding source not disclosed, making it impossible to assess institutional or industry influence
• No data on sexual function, urinary function, or psychosocial outcomes — satisfaction with appearance is one dimension of a multidimensional outcome

Strengths

• Validated outcome instrument (Penile Perception Score)
• Long follow-up (median ~15 years post-surgery) captures adolescent perspective, not just early childhood recovery
• All three severity subtypes included with subgroup analysis
• Large sample relative to condition prevalence
• No competing financial interests declared
• Pre-mailed questionnaire design reduces in-person social desirability bias

Verdict

Solid for what it is: a large, long-follow-up, single-center patient-reported outcomes study using a validated tool. The 51% reoperation rate is the number that deserves attention — it's a frank signal of surgical complexity in this population, yet regret remained low. The absence of concurrent controls is the study's honest limitation, and the authors don't hide it. This paper is worth citing for the satisfaction and regret figures but shouldn't be used to draw conclusions about penile function, urinary outcomes, or psychosexual development — those simply weren't measured.