Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Sexual functions and fertility outcomes after hypospadias repair

International Journal of Impotence Research volume 33, pages 149–163 (2021)Cite this article

Subjects

Abstract

Hypospadias is a common abnormality of the urogenital tract with a wide range of variety in its presentation and severity. The primary aim to correct hypospadias is to restore normal penile function and appearance. Although it can be corrected at any age, early correction between the 6 and 18 months of life is recommended. The functional and cosmetic outcomes have been very-well presented in the literature, although the aspects of sexuality and fertility of hypospadias repair in the long term are vague. In this narrative review, we aimed to gather the data around the sexuality and fertility outcomes of hypospadias repair and acknowledge urologists and parents of boys with hypospadias who will have a correction surgery about future sexual and fertility concerns.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Re-do hypospadias repair.

Similar content being viewed by others

References

  1. Yu X, Nassar N, Mastroiacovo P, Canfield M, Groisman B, Bermejo-Sánchez E, et al. Hypospadias prevalence and trends in international birth defect surveillance systems, 1980-2010. Eur Urol. 2019;76:482–90.

    PubMed  PubMed Central  Google Scholar 

  2. Tack L, Praet M, Van Dorpe J, Haid B, Buelens S, Hoebeke P, et al. Androgen receptor expression in preputial dartos tissue correlates with physiological androgen exposure in congenital malformations of the penis and in controls. J Pediatr Urol. 2020;16:43.e41–43.e48.

    Google Scholar 

  3. van der Zanden LF, van Rooij IA, Feitz WF, Franke B, Knoers NV, Roeleveld N. Aetiology of hypospadias: a systematic review of genes and environment. Hum Reprod Update. 2012;18:260–83.

    PubMed  Google Scholar 

  4. Radmayr C, Bogaert G, Dogan HS, Nijman R, Silay MS, Stein R, et al. EAU guidelines on paediatric urology 2020. In: European association of urology guidelines. Presented at the EAU Annual Congress Amsterdam 2020. Arnhem, The Netherlands: European Association of Urology Guidelines Office; 2020.

  5. Sommerlad BC. A long-term follow-up of hypospadias patients. Br J Plast Surg. 1975;28:324–30.

    CAS  PubMed  Google Scholar 

  6. Deibert CM, Hensle TW. The psychosexual aspects of hypospadias repair: a review. Arab J Urol. 2011;9:279–82.

    PubMed  PubMed Central  Google Scholar 

  7. Fraumann SA, Stephany HA, Clayton DB, Thomas JC, Pope JCT, Adams MC, et al. Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires. J Pediatr Urol. 2014;10:446–50.

    PubMed  Google Scholar 

  8. Bracka A. A long-term view of hypospadias. Br J Plast Surg. 1989;42:251–5.

    CAS  PubMed  Google Scholar 

  9. Aho MO, Tammela OK, Tammela TL. Aspects of adult satisfaction with the result of surgery for hypospadias performed in childhood. Eur Urol. 1997;32:218–22.

    CAS  PubMed  Google Scholar 

  10. Mor Y, Ramon J, Jonas P. Is only meatoplasty a legitimate surgical solution for extreme distal hypospadias? A long-term follow-up after adolescence. BJU Int. 2000;85:501–3.

    CAS  PubMed  Google Scholar 

  11. Kumar S, Tomar V, Yadav SS, Priyadarshi S, Vyas N, Agarwal N. Fertility potential in adult hypospadias. J Clin Diagn Res. 2016;10:Pc01–05.

    PubMed  PubMed Central  Google Scholar 

  12. Miller MA, Grant DB. Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair. Br J Urol. 1997;80:485–8.

    CAS  PubMed  Google Scholar 

  13. Mondaini N, Ponchietti R, Bonafè M, Biscioni S, Di Loro F, Agostini P, 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;68:81–5.

    PubMed  Google Scholar 

  14. Bubanj TB, Perovic SV, Milicevic RM, Jovcic SB, Marjanovic ZO, Djordjevic MM. Sexual behavior and sexual function of adults after hypospadias surgery: a comparative study. J Urol. 2004;171:1876–9.

    PubMed  Google Scholar 

  15. Aho MO, Tammela OK, Somppi EM, Tammela TL. Sexual and social life of men operated in childhood for hypospadias and phimosis. a comparative study. Eur Urol. 2000;37:95–100.

    CAS  PubMed  Google Scholar 

  16. Moriya K, Kakizaki H, Tanaka H, Furuno T, Higashiyama H, Sano H, et al. Long-term cosmetic and sexual outcome of hypospadias surgery: norm related study in adolescence. J Urol. 2006;176:1889–92.

    PubMed  Google Scholar 

  17. Schönbucher VB, Landolt MA, Gobet R, Weber DM. Psychosexual development of children and adolescents with hypospadias. J Sex Med. 2008;5:1365–73.

    PubMed  Google Scholar 

  18. Rynja SP, Wouters GA, Van Schaijk M, Kok ET, De Jong TP, De Kort LM. Long-term followup of hypospadias: functional and cosmetic results. J Urol. 2009;182:1736–43.

    PubMed  Google Scholar 

  19. Vandendriessche S, Baeyens D, Van Hoecke E, Indekeu A, Hoebeke P. Body image and sexuality in adolescents after hypospadias surgery. J Pediatr Urol. 2010;6:54–9.

    PubMed  Google Scholar 

  20. Chertin B, Natsheh A, Ben-Zion I, Prat D, Kocherov S, Farkas A, et al. Objective and subjective sexual outcomes in adult patients after hypospadias repair performed in childhood. J Urol. 2013;190:1556–60.

    PubMed  Google Scholar 

  21. Jiao C, Wu R, Xu X, Yu Q. Long-term outcome of penile appearance and sexual function after hypospadias repairs: situation and relation. Int Urol Nephrol. 2011;43:47–54.

    PubMed  Google Scholar 

  22. Wang WW, Tu XA, Deng CH, Mo JC, Zhao L, Chen LW. Long-term sexual activity status and influencing factors in men after surgery for hypospadias. Asian J Androl. 2009;11:417–22.

    PubMed  PubMed Central  Google Scholar 

  23. Rynja SP, de Jong T, Bosch J, de Kort LMO. Proximal hypospadias treated with a transverse preputial island tube: long-term functional, sexual, and cosmetic outcomes. BJU Int. 2018;122:463–71.

    PubMed  Google Scholar 

  24. Tack LJW, Springer A, Riedl S, Tonnhofer U, Weninger J, Hiess M, et al. Psychosexual outcome, sexual function, and long-term satisfaction of adolescent and young adult men after childhood hypospadias repair. J Sex Med. 2020;17:1665–75.

  25. Kiss A, Sulya B, Szász AM, Romics I, Kelemen Z, Tóth J, et al. Long-term psychological and sexual outcomes of severe penile hypospadias repair. J Sex Med. 2011;8:1529–39.

    PubMed  Google Scholar 

  26. Örtqvist L, Fossum M, Andersson M, Nordenström A, Frisén L, Holmdahl G, et al. Sexuality and fertility in men with hypospadias; improved outcome. Andrology. 2017;5:286–93.

    PubMed  Google Scholar 

  27. Örtqvist L, Fossum M, Andersson M, Nordenström A, Frisén L, Holmdahl G, et al. Long-term followup of men born with hypospadias: urological and cosmetic results. J Urol. 2015;193:975–81.

    PubMed  Google Scholar 

  28. Liu G, Yuan J, Feng J, Geng J, Zhang W, Zhou X, et al. Factors affecting the long-term results of hypospadias repairs. J Pediatr Surg. 2006;41:554–9.

    PubMed  Google Scholar 

  29. Hoag CC, Gotto GT, Morrison KB, Coleman GU, Macneily AE. Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood. Can Urol Assoc J. 2008;2:23–31.

    PubMed  PubMed Central  Google Scholar 

  30. Stein DM, Gonzalez CM, Barbagli G, Cimino S, Madonia M, Sansalone S. Erectile function in men with failed hypospadias repair. Arch Esp Urol. 2014;67:152–6.

    PubMed  Google Scholar 

  31. Ciancio F, Lo Russo G, Innocenti A, Portincasa A, Parisi D, Mondaini N. Penile length is a very important factor for cosmesis, function and psychosexual development in patients affected by hypospadias: results from a long-term longitudinal cohort study. Int J Immunopathol Pharm. 2015;28:421–5.

    Google Scholar 

  32. Andersson M, Sjöström S, Wängqvist M, Örtqvist L, Nordenskjöld A, Holmdahl G. Psychosocial and sexual outcomes in adolescents following surgery for proximal hypospadias in childhood. J Urol. 2018;200:1362–70.

    PubMed  Google Scholar 

  33. Adams J, Bracka A. Reconstructive surgery for hypospadias: a systematic review of long-term patient satisfaction with cosmetic outcomes. Indian J Urol. 2016;32:93–102.

    PubMed  PubMed Central  Google Scholar 

  34. Thiry S, Saussez T, Dormeus S, Tombal B, Wese FX, Feyaerts A. Long-term functional, cosmetic and sexual outcomes of hypospadias correction performed in childhood. Urol Int. 2015;95:137–41.

    CAS  PubMed  Google Scholar 

  35. Mureau MAM, Slijper FME, Slob AK, Verhulst FC. Genital perception of children, adolescents, and adults operated on for hypospadias: a comparative study. J Sex Res. 1995;32:289–98.

    Google Scholar 

  36. Mureau MA, Slijper FM, van der Meulen JC, Verhulst FC, Slob AK. Psychosexual adjustment of men who underwent hypospadias repair: a norm-related study. J Urol. 1995;154:1351–5.

    CAS  PubMed  Google Scholar 

  37. Jones BC, O’Brien M, Chase J, Southwell BR, Hutson JM. Early hypospadias surgery may lead to a better long-term psychosexual outcome. J Urol. 2009;182:1744–9.

    PubMed  Google Scholar 

  38. Dodds PR, Batter SJ, Shield DE, Serels SR, Garafalo FA, Maloney PK. Adaptation of adults to uncorrected hypospadias. Urology. 2008;71:682–5.

    PubMed  Google Scholar 

  39. Schlomer B, Breyer B, Copp H, Baskin L, DiSandro M. Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey. J Pediatr Urol. 2014;10:672–9.

    PubMed  PubMed Central  Google Scholar 

  40. Basile Fasolo C, Mirone V, Gentile V, Parazzini F, Ricci E, on behalf of the Andrology Prevention Week c. Premature ejaculation: prevalence and associated conditions in a sample of 12,558 men attending the andrology prevention week 2001—A Study of the Italian Society of Andrology (SIA). J Sex Med. 2005;2:376–82.

    CAS  PubMed  Google Scholar 

  41. Aulagne MB, Harper L, de Napoli-Cocci S, Bondonny JM, Dobremez E. Long-term outcome of severe hypospadias. J Pediatr Urol. 2010;6:469–72.

    CAS  PubMed  Google Scholar 

  42. Arendt LH, Lindhard MS, Kjersgaard C, Henriksen TB, Olsen J, Ramlau-Hansen CH. Parental subfertility and hypospadias and cryptorchidism in boys: results from two Danish birth cohorts. Fertil Steril. 2018;110:826–32.

    PubMed  Google Scholar 

  43. Fritz G, Czeizel AE. Abnormal sperm morphology and function in the fathers of hypospadiacs. J Reprod Fertil. 1996;106:63–6.

    CAS  PubMed  Google Scholar 

  44. Asklund C, Jørgensen N, Skakkebaek NE, Jensen TK. Increased frequency of reproductive health problems among fathers of boys with hypospadias. Hum Reprod. 2007;22:2639–46.

    CAS  PubMed  Google Scholar 

  45. Moriya K, Mitsui T, Tanaka H, Nakamura M, Nonomura K. Long-term outcome of pituitary-gonadal axis and gonadal growth in patients with hypospadias at puberty. J Urol. 2010;184:1610–4.

    PubMed  Google Scholar 

  46. Moriya K, Nakamura M, Kon M, Nishimura Y, Kanno Y, Kitta T, et al. Risk factors affecting post-pubertal high serum follicle-stimulating hormone in patients with hypospadias. World J Urol. 2019;37:2795–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Asklund C, Jensen TK, Main KM, Sobotka T, Skakkebaek NE, Jørgensen N. Semen quality, reproductive hormones and fertility of men operated for hypospadias. Int J Androl. 2010;33:80–7.

    CAS  PubMed  Google Scholar 

  48. Skakkebaek NE, Rajpert-De Meyts E, Main KM. Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects. Hum Reprod. 2001;16:972–8.

    CAS  PubMed  Google Scholar 

  49. Sharpe RM. Pathways of endocrine disruption during male sexual differentiation and masculinization. Best Pr Res Clin Endocrinol Metab. 2006;20:91–110.

    CAS  Google Scholar 

  50. Fredell L, Kockum I, Hansson E, Holmner S, Lundquist L, Läckgren G, et al. Heredity of hypospadias and the significance of low birth weight. J Urol. 2002;167:1423–7.

    PubMed  Google Scholar 

  51. Mieusset R, Soulié M. Hypospadias: psychosocial, sexual, and reproductive consequences in adult life. J Androl. 2005;26:163–8.

    PubMed  Google Scholar 

  52. Schneuer FJ, Milne E, Jamieson SE, Pereira G, Hansen M, Barker A, et al. Association between male genital anomalies and adult male reproductive disorders: a population-based data linkage study spanning more than 40 years. Lancet Child Adolesc Health. 2018;2:736–43.

    PubMed  Google Scholar 

  53. Skarin Nordenvall A, Chen Q, Norrby C, Lundholm C, Frisén L, Nordenström A, et al. Fertility in adult men born with hypospadias: a nationwide register-based cohort study on birthrates, the use of assisted reproductive technologies and infertility. Andrology. 2020;8:372–80.

    PubMed  Google Scholar 

  54. Berg R, Svensson J, Aström G. Social and sexual adjustment of men operated for hypospadias during childhood: a controlled study. J Urol. 1981;125:313–7.

    CAS  PubMed  Google Scholar 

  55. Cortes D. Cryptorchidism-aspects of pathogenesis, histology and treatment. Scand J Urol Nephrol Suppl. 1998;196:1–54.

    CAS  PubMed  Google Scholar 

  56. Spinoit A-F, Tack L, Mahmoud A, Tilleman K, Springer A, Riedl S, et al. Endocrine and reproductive outcome of men born with various degrees of hypospadias. Eur Urol Open Sci. 2020;19:e2089.

    Google Scholar 

  57. Aksglaede L, Olesen IA, Carlsen E, Petersen JH, Juul A, Jørgensen N. Serum concentration of anti-Müllerian hormone is not associated with semen quality. Andrology. 2018;6:286–92.

    CAS  PubMed  Google Scholar 

  58. Rohayem J, Luberto A, Nieschlag E, Zitzmann M, Kliesch S. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine. 2017;55:914–24.

    CAS  PubMed  Google Scholar 

  59. Rey RA, Codner E, Iñíguez G, Bedecarrás P, Trigo R, Okuma C, et al. Low risk of impaired testicular Sertoli and Leydig cell functions in boys with isolated hypospadias. J Clin Endocrinol Metab. 2005;90:6035–40.

    CAS  PubMed  Google Scholar 

  60. Kumar MV, Harris DL. A long term review of hypospadias repaired by split preputial flep technique (Harris). Br J Plast Surg 1994;47:236–40.

  61. Marrocco G, Vallasciani S, Fiocca G, Calisti A. Hypospadias surgery: a 10-year review. Pediatr Surg Int. 2004;200–3.

  62. Lam PN, Greenfield SP, Williot P. 2-stage repair in infancy for severe hypospadias with chordee: long-term results after puberty. J Urol. 2005;174:1567–72.

  63. Nelson CP, Bloom DA, Kinast R, Wei JT, Park JM. Long-term patient reported outcome and satisfaction after oral mucosa graft urethroplasty for hypospadias. J Urol. 2005.

  64. Örtqvist L, Fossum M, Andersson M, Nordenström A, Frisen L, Holmdahl G, Nordenskjöld A. Sexuality and fertility in men with hypospadias; improved outcome. Andrology. 2017;5:286–93.

  65. Majstorovic M, Bizic M, Nikolic D, Stojanovic B, Bencic M, Joksic I, Djordjevic M. Psychosexual functioning outcome testing after hypospadias repair. Healthcare (Basel). 2020;8:32.

Download references

Acknowledgements

The authors acknowledge the participants for their cooperation.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. SH is a PhD fellow supported by Novo Nordisk Foundation.

Author information

Authors and Affiliations

  1. Department of Urology, Selcuk University School of Medicine, 42250, Konya, Turkey

    Murat Gul

  2. Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, 2100, Copenhagen, Denmark

    Simone Hildorf

  3. Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey

    Mesrur Selcuk Silay

Authors
  1. Murat Gul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Hildorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mesrur Selcuk Silay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mesrur Selcuk Silay.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gul, M., Hildorf, S. & Silay, M.S. Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res 33, 149–163 (2021). https://doi.org/10.1038/s41443-020-00377-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-020-00377-5

This article is cited by

Search

Advanced search

Quick links