Psychological Outcomes After Hypospadias Repair: Does Age at Surgery Matter? A Systematic Review

Hypospadias represents one of the most frequent congenital anomalies in male neonates, and corrective surgery is generally advised within the first 6 to 18 months of life. Nevertheless, the most appropriate time to perform the repair remains debated, especially concerning its impact on patients' long-term psychological well-being. The present systematic review evaluated how the age at which surgery is performed affects subsequent psychological and psychosexual outcomes. A structured search of PubMed, ScienceDirect, Embase, and Cochrane Library was undertaken in May 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting framework. Eligible studies were comparative investigations and cohorts that reported psychiatric, psychological, or psychosexual outcomes after primary hypospadias correction in pediatric populations. Two independent reviewers appraised risk of bias with the Newcastle-Ottawa Scale, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was applied to assess the certainty of evidence. As substantial heterogeneity precluded statistical pooling, a narrative synthesis was conducted. A total of 15 studies (more than 10,000 patients), published between 1997 and 2025 and originating from Europe, Asia, the Middle East, Australia, and North America, were ultimately included. The majority of patients who underwent hypospadias repair reached adequate psychosocial functioning in the long term, although a recurring subgroup demonstrated symptoms of anxiety, depression, obsessive-compulsive features, or dissatisfaction with body image. Large registry-based cohorts indicated heightened susceptibility to neurodevelopmental and psychiatric conditions, whereas smaller institutional series tended to highlight concerns related to genital self-perception. Whether surgical timing meaningfully alters these outcomes was not consistently supported across studies. Overall certainty of the evidence ranged from low to moderate. Taken together, psychological outcomes following hypospadias correction tend to be favorable, but the role of operative age in shaping long-term psychosocial well-being remains unclear. Well-designed prospective investigations with extended follow-up are warranted to address this question.