Search

Hypospadias is a congenital defect of the penis, which occurs in one out of 200-300 newborn boys. The meatus of the urethra is not positioned at the top of the glans, but somewhere between the glans and the scrotum. Surgical correction of hypospadias is performed around their first birthday, sometimes combined with a correction of a penile curvature. The goals of treatment are a forward, straight urinary stream, a straight penis in erection and a normal penile appearance. However, puberty can cause complications due to penile growth and sexual interest is increasing during this phase. Therefore, the final outcomes of surgical corrections can only be assessed after puberty. In this thesis boys with hypospadias, operated between 1987-1993, were evaluated at the age of 18 years old to assess their long-term micturition, sexual and cosmetic outcomes in hypospadias. In general, hypospadias patients had satisfying outcomes, but more severe hypospadias - those with ameatus near the scrotum at first - have a higher chance of complications, sexual outcomes and cosmetic outcomes. Subanalysis of the group was done, revealing no negative outcomes of preoperative stimulation of the penis with testosterone, the foreskin could be preserved in mild hypospadias patients and severe hypospadias patiënt can be treated with a single-stage surgical technique (Duckett tube) with fairly good results.

Spinal dysraphism (SD) is a common name for a group of heterogeneous congenital conditions of the central nervous system, of which myelomeningocele is the most well-known form. SD has a wide spectrum of symptoms, mainly caused by neurological deficits. The bladder and pelvic floor are also affected often and problems with bladder and pelvic floor may give rise to renal damage or even failure. SD is mostly readily apparent at birth and are followed-up intensly during childhood. After the age of 18, however, many SD-patients disappear from regular follow-up. Literature on adult SD-patients is rare and it is relatively unknown what the long-term outcomes of treatments initiated during childhood are. Moreover, it is also unknown of which modalities follow-up of these patients should exist (although some recommendations are made in existing Guidelines, these are hardly being followed and are not evidence based). This thesis studies 1) what is known in the literature about upper and urinary tract outcomes in SD-patients, 2) what outcomes of treatments from the childhood period are; 3) what the outcomes with regard to bladder- and kidney dysfunction are in various subgroups of SD-patients, as well as of other organ systems; 4); with which modalities urological follow-up should be organized. The studies were done using patient data from a prospectively made dataset, retrospective cohort studies and interviews with patients and caregivers.