Mental health diagnoses among patients with complex hypospadias

This study examines mental health status of patients with complex hypospadias, which include proximal (penoscrotal, scrotal or perineal) hypospadias or hypospadias of any degree with additional urogenital anomalies.

Eligible patients of different ages (24% adults) were identified within three geographically and demographically diverse Kaiser Permanente health plans using an electronic health record screening algorithm, followed by a review of clinical notes. For each patient, we selected 10 male referents with no evidence of atypical sex genital development, matched on age, race/ethnicity, and study site, and all records were linked to mental health (neurodevelopmental or psychiatric) diagnoses. Poisson regression models, accounting for matching and controlling for enrollment duration, were used to calculate prevalence ratios (PR) and 95% confidence intervals (CI) for various mental health diagnoses.

Over one-half (54%) of 335 patients with complex hypospadias and 38% of 3,346 male referents received at least one mental health (neurodevelopmental or psychiatric) diagnosis (PR = 1.47; 95% CI: 1.25, 1.71). The differences in mental health morbidity between patients with hypospadias and male referents were particularly pronounced for intellectual disabilities (PR = 10.26; 95% CI: (4.61, 22.86) and feeding and eating disorders (PR = 3.41; 95% CI; (1.45, 8.02). When the data were examined separately for proximal hypospadias and other hypospadias with additional urogenital anomalies, the PR estimates for most categories were either similar or with largely overlapping 95% CIs.

Individuals with complex hypospadias carry a greater mental health burden than those without hypospadias. Management of mental health comorbidities is a healthcare priority in this population.