ORIGINAL ARTICLE
Bali Medical Journal (Bali MedJ) 2025.
Volume 14.
Number 3: 657-662 P-ISSN.
E-ISSN: 2528-6641
The analysis of paternity and long-term sexual outcomes in adult hypospadias patients after urethroplasty: a systematic review and meta-analysis Lia Oktarina1*.
Tomy Muhamad Seno Utomo1
ABSTRACT
Department of Urology.
Hasan Sadikin Academic Medical Center/Faculty of Medicine.
Universitas Padjadjaran.
Bandung.
Indonesia.
*Corresponding author:
Lia Oktarina.
Department of Urology.
Hasan Sadikin Academic Medical Center/Faculty of Medicine.
Universitas Padjadjaran.
Bandung.
Indonesia.
liaoktarina0110@gmail.
Received: 2025-07-06 Accepted: 2025-09-13 Published: 2025-10-10 Background: Hypospadias patients need to undergo surgical management during childhood to enable a satisfactory quality of life, including sexual function in adulthood.
While previous clinical trials have predominantly focused on urinary functional outcomes, recent investigations have expanded to examine sexual and reproductive consequences.
Thus, this study aims to evaluate the postoperative clinical outcome and paternity in adult hypospadias patients after urethroplasty for hypospadias repair in childhood.
Method: A systematic literature search of electronic databases was performed based on PRISMA statements.
The databases searched included PubMed.
EbscoHost.
Scopus, and Cochrane Library.
Included studies are clinical trials that evaluate adult patients with hypospadias repair during childhood with various urethroplasty interventions, comparing postoperative clinical and sexual function, specifically paternity.
All studies were evaluated based on the Newcastle-Ottawa scale and synthesized quantitatively with Review Manager 5.
Result: Among 185 studies in the initial search, only four cohort studies are eligible in this review, representing the analysis of 567 adult patients across the globe.
Our analysis using a fixed-effect model revealed no statistically significant odds ratio 85 .
%CI: 0.
55Ae1.
31, p=0.
I2=90%].
Conclusion: Urethroplasty in adults with repaired hypospadias showed no differences in paternity and sexual outcomes.
Keywords: hypospadias, paternity, sexual function, surgery, urethroplasty.
Cite This Article: Oktarina.
Utomo.
The analysis of paternity and long-term sexual outcomes in adult hypospadias patients after urethroplasty: a systematic review and meta-analysis.
Bali Medical Journal 14.
: 657-662.
DOI:
15562/bmj.
INTRODUCTION
Hypospadias is one of the most frequent congenital urogenital disorders, affecting 2% of male neonates globally.
Numerous environmental and genetic factors have been linked to interfering with the urethral plateAos normal hormonal maturation, while the exact cause is still mostly unclear.
1,2 The primary shortterm objective of hypopadias surgery is to achieve a penile morphology as near to normal anatomy as possible through structural correction.
Surgical treatment is typically advised between 6 and 18 months of age.
Surgical performed in early life, seeks to promote the proper functioning of urinary mechanisms and lay the groundwork for effective sexual performance in later life.
The aims of such interventions include ensuring adequate urinary flow dynamics, uncomplicated erectile function, and normal ejaculatory performance, as well as addressing aesthetic factors such as suitable meatal location, foreskin restoration, and symmetrical scrotum Nonetheless, longitudinal research investigating the diverse effects of surgical correction on outcomes in adulthood is still limited.
Research indicates that hypospadias may affect genital development during puberty and may have an effect on adult penile function, even with early surgical While previous clinical trials have predominantly focused on urinary functional outcomes, recent investigations have expanded to examine sexual Open Bali Medical access:Journal 14.
: 657-662 | doi: 10.
15562/bmj.
Understanding long-term implications is crucial for establishing appropriate follow-up protocols and management strategies.
Although several comparative studies have examined sexual
function between hypospadias patients and control populations, with particular
attention to compromised sexual
psychology and penile development in proximal cases, these investigations have predominantly emphasized body image Consequently, regarding the capacity for satisfactory addressed, leaving significant knowledge gaps in our understanding of long-term
outcomes for both patients and their This review examines current
ORIGINAL ARTICLE
available evidence of the long term impact on paternity in adults diagnosed with hypospadias after certain urethroplasty techniques to specifically address the extended sexual and fertility outcomes following hypospadias repair.
METHOD
Search Strategy Literature search was carried out based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements across databases such as PubMed.
EbscoHost, the Cochrane Library, and Scopus.
10 Authors used a blend of MeSH terms and keywords for a thorough search.
Keywords may include AuHypospadia,Ay AuPostoperative Urethroplasty,Ay AuPaternity,Ay AuSexual Function,Ay and related synonyms.
Study Selection This study included the following criteria that must be met for inclusion: articles in English published from the inception of the databases to January 2025, focusing on long term postoperative outcomes in adult patients with hypospadia repair during childhood with various urethroplasty techniques by evaluating the paternity and sexual functions of long term postoperative Paternity rate was defined as the age at which the patients who had offspring had married, while sexual functions were defined as experiences in sexual intercourse and ejaculation, evaluated using validated questionnaires such as the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF-.
Both were the primary outcomes of this study since they are highly associated with the longterm outcomes in adult hypospadias after The studies were excluded if they were not published in English, solely focused on animal models or in vitro experiments, studies about adult primary hypospadias repair, patients with sex development disorders, two with mixed gonadal dysgenesis, and one with XX male, irretrievable full text, and studies that did not fulfill the methodological quality based on Scopus or Sinta indexes.
Subsequently, all relevant articles were organized using Mendeley Reference Manager, which was employed to eliminate duplicate records both automatically and manually.
The final collection of articles was then exported to Microsoft Excel for screening based on title and abstract, followed by a meticulous examination of the full texts.
During the selection procedure, any disputes were settled by discussion and agreement.
Data Extraction Authors extracted data from the literature by recording, including publication year, study design, participant demographics, detailed descriptions of the urethroplasty, and the outcomes of paternity and sexual Extraction will be conducted independently by the research team, ensuring consistency and accuracy in the data collated.
In cases where disagreements arose during the screening or data extraction process, the authors resolved them through mutual discussion.
A third independent author served as an arbitrator and made the final decision if a consensus could not be reached.
Assessment of Risk of Bias Authors independently evaluated the quality of the research papers using distinct tools, the Newcastle-Ottawa scale (NOS) for observational studies.
The NOS employs three criteria to assess observational studies: sample selection, study comparability, and study result, encompassing eight items with scores ranging from 0 to 9.
Scores within 0-3, 4-6, and 7-9 correspond to studies of poor, moderate, and high-quality, respectively.
In case of any disagreements between the two authors during the assessment process, they were resolved through consensus.
Statistical Analysis Review Manager 5.
4 (The Nordic Cochrane Centre.
The Cochrane Collaboration.
Copenhagen.
Denmar.
was used to conduct the statistical analysis.
Using dichotomous outcomes, the event parameter was evaluated.
The Q or I2 test was used to calculate the degree of trial When there was evidence of considerable trial heterogeneity (P0.
and/or I2>50%), a random-effects model was applied.
RESULTS
Initial search found 185 potential articles.
after excluding duplicates, there are 155 unique articles.
Following that, 75 records had a relevant title and abstract, and only 20 of them are available for full-text access.
After screening based on eligibility criteria and exclusive criteria, 4 records are eligible for quantitative and qualitative synthesize in this study.
These studies are cohort studies with 4 cohorts recruiting 567 adult patients with a history of hypospadias repair during childhood across the globe.
Figure 1 presents the comprehensive literature search strategy and screening Table 1 shows the characteristics of the included studies.
All the included studies are high-quality articles based on the NOS score (Table .
, representing the robust methodology and results for each Two cohort studies were analyzed to assess the odds ratio between adult postrepaired hypospadias and healthy control groupsAo evaluation of paternity events.
Our analysis using a fixed-effect model revealed no statistically significant difference with an odds ratio of 0.
%CI: 0.
55 Ae 1.
p= 0.
I2=90%] as seen in Figure 2.
DISCUSSION