Individuals with complex hypospadias carry a greater mental health burden than those without hypospadias, with over half receiving at least one mental health diagnosis compared to 38% of matched male referents.
Key Findings
Results
Patients with complex hypospadias had significantly higher prevalence of any mental health diagnosis compared to matched male referents.
54% of 335 patients with complex hypospadias received at least one mental health (neurodevelopmental or psychiatric) diagnosis
38% of 3,346 male referents received at least one mental health diagnosis
Prevalence ratio (PR) = 1.47; 95% CI: 1.25, 1.71
Poisson regression models accounting for matching and controlling for enrollment duration were used
Referents were matched 10:1 on age, race/ethnicity, and study site
Results
Intellectual disabilities showed the most pronounced difference between patients with complex hypospadias and male referents.
PR = 10.26; 95% CI: 4.61, 22.86 for intellectual disabilities
This represented the largest magnitude of association among all mental health categories examined
The finding was based on comparison of 335 hypospadias patients to 3,346 matched male referents
Results
Feeding and eating disorders were significantly more prevalent in patients with complex hypospadias than in male referents.
PR = 3.41; 95% CI: 1.45, 8.02 for feeding and eating disorders
This was the second most pronounced category-specific difference identified
Feeding and eating disorders represented a distinct diagnostic category from psychiatric disorders
Methods
The study population was drawn from three geographically and demographically diverse Kaiser Permanente health plans using electronic health record screening followed by clinical note review.
335 patients with complex hypospadias were identified
Complex hypospadias was defined as proximal (penoscrotal, scrotal, or perineal) hypospadias or hypospadias of any degree with additional urogenital anomalies
24% of eligible patients were adults
An electronic health record screening algorithm followed by review of clinical notes was used for case identification
10 male referents with no evidence of atypical genital development were selected per patient
Results
Mental health morbidity patterns were similar regardless of whether patients had proximal hypospadias or hypospadias with additional urogenital anomalies.
Data were examined separately for proximal hypospadias and other hypospadias with additional urogenital anomalies
PR estimates for most diagnostic categories were either similar or had largely overlapping 95% CIs between the two subgroups
This suggests the mental health burden is not substantially different between these two definitions of complex hypospadias
Conclusions
The authors concluded that management of mental health comorbidities is a healthcare priority in the complex hypospadias population.
Both neurodevelopmental and psychiatric diagnoses were examined
The study covered patients of different ages including a substantial proportion (24%) of adults
The findings applied across geographically and demographically diverse populations within Kaiser Permanente health plans
What This Means
This research suggests that people born with complex hypospadias — a condition where the urinary opening is not at the tip of the penis and may be accompanied by other genital abnormalities — are significantly more likely to have mental health diagnoses than males without the condition. More than half of the 335 patients with complex hypospadias in this study had at least one mental health or neurodevelopmental diagnosis, compared to about 38% of more than 3,300 matched comparison males. The strongest differences were seen for intellectual disabilities (about 10 times more common) and feeding and eating disorders (about 3.4 times more common).
The study used medical records from three Kaiser Permanente health plan regions across the United States, including both children and adults (about 24% were adults), giving it a broad and diverse sample. Researchers carefully matched each hypospadias patient with 10 comparison males of similar age, race/ethnicity, and location to make the comparison as fair as possible. The elevated mental health burden was seen regardless of whether the complex hypospadias was defined as being in a proximal location or as hypospadias combined with other urogenital anomalies.
This research suggests that the healthcare needs of people with complex hypospadias extend well beyond surgical repair of the physical condition. The findings highlight that mental health screening and support should be considered a routine part of care for this population, across the lifespan and not just in childhood. Clinicians and families may benefit from awareness that these co-occurring conditions are common and may require dedicated attention alongside medical management.
Yacoub R, Kaabi O, Gardner M, Getahun D, Kogan B, Lash T, et al.. (2026). Mental health diagnoses among patients with complex hypospadias.. World journal of urology. https://doi.org/10.1007/s00345-026-06443-9