Quality of life in hypospadias: Systematic review of HRQoL-based analyses.

BACKGROUND

While anatomical success rates following hypospadias repair exceed 90%, the psychological and social impact remains poorly understood. This synthesis aimed to integrate and assimilate published evidence on quality-of-life outcomes in hypospadias patients, examining satisfaction, psychological adjustment, and predictive factors.

METHODS

Nine studies encompassing 8409 participants (467 cases; 7942 controls) with corrected and uncorrected hypospadias were analysed. Parameters included health-related quality of life (HRQoL), patient satisfaction, genital self-perception, sexual function, and psychological adjustment.

RESULTS

Overall outcomes were favourable, with high patient satisfaction (92.6%), excellent functional results (>90% acceptable HOSE scores), and HRQoL scores comparable to normative populations. Decision regret remained minimal (79.0% patients, 81.7% parents reporting no regret). However, a striking paradox emerged: significant psychosocial challenges persist in a substantial minority. Genital self-perception was consistently impaired compared to controls (13.3 vs 15.8, p < 0.001), with 53% of patients scoring below thresholds indicating need for psychological support. Predictive modelling revealed that negative genital self-perception and reduced orgasmic function depicted a significant association with impaired mental health-related quality of life (R2 = 0.51), while medical variables showed no predictive value. Comparison with untreated hypospadias demonstrated clear surgical benefits.

CONCLUSIONS

Hypospadias repair achieves favourable quality of life outcomes with high satisfaction and minimal regret. Comparison with untreated cases demonstrates clear benefits of surgical intervention across multiple quality of life domains. However, in a significant subset of patients, persistent genital self-perception impairment despite successful surgical outcomes highlights the need for enhanced psychological support and long-term follow-up incorporating patient-centred measures.