Related Experiment Video
Updated: Jun 25, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Psychological Outcomes After Hypospadias Repair: Does Age at Surgery Matter? A Systematic Review
Randy Fauzan1, Irfan Wahyudi1, Gerhard Reinaldi Situmorang1
1Urology, Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo, Jakarta, IDN.
Insights
The optimal timing for hypospadias repair in male neonates is debated, with this review finding psychological outcomes generally favorable but the impact of surgical age unclear. Further research is needed to understand long-term psychosocial well-being after hypospadias correction.
Area of Science:
- Pediatric Urology
- Developmental Biology
- Psychosocial Health
Background:
- Hypospadias is a common congenital anomaly in male neonates requiring surgical correction.
- The optimal age for hypospadias repair is debated, particularly regarding long-term psychological and psychosexual impacts.
- Understanding the influence of surgical timing on patient outcomes is crucial for clinical practice.
Purpose of the Study:
- To systematically review the literature on the impact of surgical timing on psychological and psychosexual outcomes after hypospadias repair.
- To synthesize evidence regarding the relationship between age at repair and long-term patient well-being.
- To identify gaps in knowledge and guide future research directions.
Main Methods:
- Systematic literature search of PubMed, ScienceDirect, Embase, and Cochrane Library (May 2025).
- Inclusion of comparative studies and cohorts reporting psychiatric, psychological, or psychosexual outcomes.
- Risk of bias assessment (Newcastle-Ottawa Scale) and certainty of evidence evaluation (GRADE framework).
- Narrative synthesis due to study heterogeneity.
Main Results:
- Fifteen studies (over 10,000 patients) published between 1997-2025 were included.
- Most patients achieved adequate psychosocial functioning post-hypospadias repair.
- A subgroup experienced anxiety, depression, or body image dissatisfaction; large cohorts noted increased neurodevelopmental/psychiatric risks.
Conclusions:
- Psychological outcomes after hypospadias correction are generally favorable.
- The specific role of operative age in influencing long-term psychosocial well-being remains inconclusive.
- High-quality prospective studies with extended follow-up are necessary to clarify the impact of surgical timing.
Abstract:
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.
