Abstract：
BACKGROUND: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias.
METHODS: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery.
RESULTS: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity.
CONCLUSIONS: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.
METHODS: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery.
RESULTS: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity.
CONCLUSIONS: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.
摘要：
背景：对尿道下裂的长期结果的研究集中在手术技术和功能结果上，直到最近，患者对外观和心理社会结果的满意度才被考虑。这项研究的目的是提供一项基于证据的系统评价，以评估儿童尿道下裂手术后青少年和成人患者对美容结果的看法。
方法：根据PRISMA和PICO指南进行了系统评价，以及使用牛津循证医学中心系统进行评估的研究。MEDLINE,PsycInfo,EMBASE,和CINAHL数据库从1974年到2014年搜索包含患者对外观的感知的临床研究，畸形,尿道下裂手术后的社交尴尬。
结果：共检索到495篇出版物，其中28人符合纳入标准。由于研究设计/结果测量，异质性数据进行了叙述合成。结果表明（i）患者对阴茎大小的看法与规范没有很大差异；（ii）对外观发现的看法不一致，部分是由于改进了手术技术；(iii)接近的患者，或者已经到达，性成熟持有更多的负面看法，与青春期前的同行相比，对手术的美容结果更重要；（iv）患者报告对畸形和社会尴尬的看法较高；（v）缺乏使用经过验证的测量工具评估患者对美容结果的长期看法的数据，特别是对于已经达到生殖器成熟的患者。
结论：临床青春期后随访和方法学研究的方案，使用经过验证的评估工具，需要准确评估尿道下裂手术的美容和心理结果。
方法：根据PRISMA和PICO指南进行了系统评价，以及使用牛津循证医学中心系统进行评估的研究。MEDLINE,PsycInfo,EMBASE,和CINAHL数据库从1974年到2014年搜索包含患者对外观的感知的临床研究，畸形,尿道下裂手术后的社交尴尬。
结果：共检索到495篇出版物，其中28人符合纳入标准。由于研究设计/结果测量，异质性数据进行了叙述合成。结果表明（i）患者对阴茎大小的看法与规范没有很大差异；（ii）对外观发现的看法不一致，部分是由于改进了手术技术；(iii)接近的患者，或者已经到达，性成熟持有更多的负面看法，与青春期前的同行相比，对手术的美容结果更重要；（iv）患者报告对畸形和社会尴尬的看法较高；（v）缺乏使用经过验证的测量工具评估患者对美容结果的长期看法的数据，特别是对于已经达到生殖器成熟的患者。
结论：临床青春期后随访和方法学研究的方案，使用经过验证的评估工具，需要准确评估尿道下裂手术的美容和心理结果。
