Association of Anogenital Distance with Hypospadias Severity and Chordee: A Prospective Observational Study

Anogenital distance (AGD) is a sexually dimorphic parameter. Although reduced AGD has been associated with hypospadias, its relationship with hypospadias severity and chordee remains incompletely defined. In this study, we aim to measure AGD in patients with hypospadias and compare it with published age-specific nomogram. We also aim to find an association of measured AGD with hypospadias severity and chordee.

This prospective observational study included all boys presenting with hypospadias for the first between November 2023 and April 2025. AGD was measured under anesthesia before surgery; the severity of chordee was assessed intraoperatively by artificial erection test and categorized as mild (<30°) or severe (>30°). AGD values were with published age-specific reference values and analyzed as a continuous variable and compared across hypospadias subtypes and chordee severity. The association between AGD and hypospadias and chordee severity was also evaluated.

Among 102 patients, six patients had AGD within the published age-specific reference percentile range, whereas 96 patients had smaller AGD; this difference was statistically significant (P = 0.0001). Chordee severity increased significantly with more proximal meatal location. Mean AGD showed a decreasing trend from distal to proximal hypospadias and also with increasing chordee severity.

We observed that children with hypospadias had shorter AGD with more proximal meatal location and increasing chordee severity. The measured AGD was found to be smaller than the age-specific published nomograms. AGD may serve as an adjunctive marker reflecting the degree of genital developmental disruption.