Most adult men with a relatively common birth defect of the penis that is uncorrected are satisfied with the appearance of their penis and report few functional problems, results of a survey suggest.

The defect, known as hypospadias, occurs when the urinary outlet is located on the underside of the head of the penis, instead of at the tip as is normal. The defect can be corrected with surgery. If left untreated, the defect can raise the risk of urination and sexual function problems later in adulthood.

“Parents should be told that a child with mild hypospadias may be satisfied with the appearance of their phallus and may be able to void in the standing position without surgical correction,” Dr. Peter R. Dodds from Norwalk Hospital, Norwalk, Connecticut told Reuters Health. “The chances of cosmetically and functionally improved outcomes may be improved if successful surgery is performed although there has been no randomized trial to demonstrate this to be true.”

The concept for the survey, Dodds explained, “began when the parents of a baby boy asked me why I was so certain that their child would be unhappy with the appearance of his penis and that he would void onto his shoes if he didn’t have corrective surgery for his hypospadias. The best answer I could come up with was that ‘It is what I was taught.’ I was mortified by my ridiculous response and decided to study the matter.”

According to Dodds, only 3 of 56 adult men with uncorrected hypospadias surveyed expressed dissatisfaction with the appearance of their penis, and only 1 of these patients had presented with a chief complaint referable to the hypospadias.

Nine of the men had undergone failed or incomplete hypospadias repairs as children, and none of these men were dissatisfied with the appearance of their penis. Eighteen men were unaware they had an abnormality of the penis, and another 6 were aware of their hypospadias only because a health care provider had pointed out the abnormality to them.

Just over one third of the men reported spraying or abnormal angulation of the urinary stream, the investigators note, but only 3 patients reported that they preferentially sit to void.

All but 2 of 43 men who had attempted fertility were successful, the researchers say, and the 2 known to be infertile had significantly reduced concentrations of sperm in ejaculated semen.

Fifty-three of the men had been sexually active without difficulty, 2 had not yet had a sexual partner, and 1 reported intermittent problems with failure to ejaculate but nevertheless had fathered children.

“I was somewhat surprised that hypospadias seems to be a non-issue for so many adults,” Dodds said. “One of our patients stated that he had had many sexual partners before a nurse he was dating informed him that he was ‘built different’ than most men. He said they laughed about it and that it was not a concern to either.”

However, “I intuitively believe that all boys with marked hypospadias and curvature will be disadvantaged by their birth anomaly and should be considered for surgery,” Dodds added.

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SOURCE: Urology April 2008.