Psychosexual development, psychosocial adjustment and quality of life of children and adolescents with hypospadias

Objectives: To conduct a comprehensive cross-sectional study on health-related quality (HRQoL) of life, psychological adjustment and psychosexual development of children and adolescents after hypospadias repair and to identify sociodemographic, medical and psychosocial predictors of outcome.Prior to the actual investigation, a systematic review of previous research was conducted, which showed a lack of methodologically sound studies on the topic concerned.Study design: Seventy-seven boys (7-17 years) operated on for hypospadias at the University Children's Hospital Zurich were investigated by means of a standardized interview.Patients mothers' were asked to fill out a questionnaire and medical data was retrieved from the patients' records.Scores were compared to an age-matched control group consisting of 77 boys after hernia repair.Predictive values of medical and psychosocial variables were assessed.Main outcome measures: Child-and mother-rated HRQoL was evaluated by the TNO-AZL Child Quality of Life Questionnaire and psychological adjustment by the Child Behavior Checklist.The assessment instruments assessing psychosexual development comprised the self-developed Pediatric Penile Perception Score, the Gender-role Questionnaire by Ijntema and Cohen-Kettenis and a self-developed questionnaire on first sexual experiences and sexual attitude.Results: Compared to the controls, self-reported HRQoL of hypospadias patients was lower in most dimensions.In contrast, mother-reported HRQoL and psychological adjustment did not differ between the two groups.Likewise, boys with hypospadias did not significantly differ from healthy controls with regard to penile self-perception, gender-role behavior, first sexual experiences and sexual attitude.Regarding predictors of outcome measures, higher age and "being less ashamed of penile appearance" predicted better self-reported HRQoL, while a positive penile self-perception, the patient's experience of not having been teased about his penis and more severe hypospadias contributed to better mother-reported HRQoL.Psychological adjustment was best predicted by higher age, Swiss nationality, more severe hypospadias and the patient's experience of not having been teased about his penis.With regard to psychosexual development, younger age and the patient's knowledge of hypospadias contributed to the prediction of a positive penile self-perception, whereas a more pronounced masculine gender-role behavior was best predicted by younger age at final surgery.