Psychosocial and Sexual Outcomes in Adolescents following Surgery for Proximal Hypospadias in Childhood
Psychosocial and Sexual Outcomes in Adolescents following Surgery for Proximal Hypospadias in Childhood
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DOI：
10.1016/j.juro.2018.06.032
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发表时间：
2018-12-01
影响因子：
6.6
通讯作者：
Holmdahl, Gundela
中科院分区：
文献类型：
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作者：
Andersson, Marie;Sjostrom, Sofia;Holmdahl, Gundela
目的：我们评估接受近端尿道下裂手术的青少年的心理社会结局、性心理发展和性功能。我们假设与同龄人相比，这些结果会受到损害。材料和方法：在1996年至2005年间，我们确定了55名年龄在14岁或以上的男性接受了阴茎阴囊至会阴（术中定义）尿道下裂手术。共33例患者（年龄14 ~ 25岁，中位年龄17.5岁）通过网络自编问卷，完成经验证的心理总体幸福感指数、青少年和成人身体自尊量表和阴茎感知评分，并进行临床评估。31例远端尿道下裂患者（中位年龄19岁，范围14 ~ 35岁）和25例年龄匹配的健康男性（17.5岁，范围14 ~ 25岁）作为对照组。结果：对性的兴趣、性年龄和对性体验的满意度在患者和对照组之间具有可比性。3例近端尿道下裂患者（10%）和1例对照（4%）报告偶有勃起问题。近端尿道下裂3例（11%），远端尿道下裂1例（3%），对照组1例（4%）确认射精。有效问卷之间的结果没有差异。尿道下裂近端患者对阴茎长度的不满意程度（39%）高于对照组（12%,p = 0.049）。对于身体接触，10名患者（38%）表示不确定。近端尿道下裂患者在学校获得额外支持的频率更高（p = 0.024 vs远端尿道下裂，p = 0.068 vs对照组）。结论：尽管担心阴茎长度，但性经历与其他青少年相当，尽管超过三分之一的近端尿道下裂患者在与身体接触的欲望有关的问题上表现出不确定性。在近端尿道下裂患者中，学校的专门辅导更为常见。在整个儿童时期进行持续的随访，允许额外的年龄，充分的信息和支持是必要的。
Purpose: We evaluated psychosocial outcomes, psychosexual development and sexual function in adolescents who had undergone surgery for proximal hypospadias. We hypothesized that these outcomes would be impaired compared to peers.Materials and Methods: We identified 55 males age 14 years or older who underwent surgery for penoscrotal to perineal (intraoperatively defined) hypospadias between 1996 and 2005. A total of 33 patients with a median age of 17.5 years (range 14 to 25) answered a Web based questionnaire with self-constructed questions, completed the validated Psychological General Well-Being Index, Body-Esteem Scale for Adolescents and Adults and Penile Perception Score, and underwent clinical evaluation. A total of 31 patients with distal hypospadias (median age 19 years, range 14 to 35) and 25 age matched healthy men (17.5 years, range 14 to 25) served as controls.Results: Interest in sex, age at sexarche and satisfaction with sexual experiences were comparable between patients and controls. Three patients with proximal hypospadias (10%) and 1 control (4%) reported occasional erectile problems. Three patients with proximal hypospadias (11%), 1 patient with distal hypospadias (3%) and 1 control (4%) affirmed anejaculation. There were no differences in results between validated questionnaires. Patients with proximal hypospadias were more dissatisfied with penile length (39%) compared to controls (12%, p = 0.049). Concerning physical contact, 10 patients (38%) expressed uncertainty. Extra support in school was more frequent among patients with proximal hypospadias (p = 0.024 vs distal hypospadias, p = 0.068 vs control group).Conclusions: Despite concerns regarding penile length, sexual experiences were comparable to those of other adolescents, although more than a third of patients with proximal hypospadias demonstrated uncertainty on questions relating to desire for physical contact. Specialized tutoring in school was more common in patients with proximal hypospadias. Continuous followup throughout childhood allowing extra time for age adequate information and support is warranted.