Self-reported outcomes in adults with hypospadias: A meta-analysis of patient satisfaction and quality-of-life metrics.

Abstract

Introduction: Hypospadias reconstruction seeks to correct structural problems associated with this congenital condition to improve patient quality-of-life (QoL) and overall well-being. While corrective surgery can lead to major functional and psychosocial improvements, some patients experience continuing problems that require additional procedures. This study evaluates patient-reported outcomes (PROs) in hypospadias care, particularly penile satisfaction and QoL after surgery, to fill this essential gap in the literature.

Methods: Computerized bibliographic searches were performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials. Up to July 30th, 2024. Funnel plots and ROBINS-I questioners were used to assess publication and overall risk of bias. The random effect model was applied to determine the pooled parameters when I² was more than 50 %. The fixed effect model was applied to the contrary. Confidence intervals (CIs) of 95 % were calculated.

Result: Eight studies were selected which included a total of 726 patients who self-evaluated satisfaction levels following hypospadias repair procedures the earliest of which was published on 2008. Three studies involving 144 people also examined QoL metrics among patients underwent hypospadias repair, with low publication bias and low-to-moderate overall risk of bias across the included studies. The pooled results indicated that subjects without hypospadias (control group) reported significantly higher satisfaction with penile appearance in 4 studies with continuous data (mean difference -1.43, 95 % CI -2.79-0.07, p < 0.05, high heterogeneity I² = 90 %, p<0.05) and 4 studies with dichotomous data (odds ratio 0.1, 95 % CI 0.07-0.15, p < 0.05, low heterogeneity I² = 0 %, p = 0.48). There is no significant difference of QoL between two groups (mean difference 0.62, 95 % CI -2.05-3.28, p < 0.65, moderate level of heterogeneity I² = 69 %, p < 0.05).

Conclusion: Our research shows that post-hypospadias repair surgery patient satisfaction is inadequate, but their quality of life is equivalent to those without hypospadias. This study enhances understanding of hypospadias patients' key issues and suggests ways to improve quality of life after corrective surgery.