Published studies have been inconsistent regarding the correlation between hypospadias and increased risk factors related to psychological functioning. A recent systematic review of the literature found 13 qualified studies with varying methodologies and inconclusive findings. We sought to obtain prospective pilot data on the psychological adjustment of children who have undergone multiple surgical procedures for treatment of hypospadias. No prior study of hypospadias patients has used the Behavior Assessment System for Children, Second Edition (BASC-2), despite its strong psychometric properties and advantages over previously used instruments. Continuation of the current study would be supported by a significantly higher prevalence of at-risk or clinical range scores among hypospadias patients.
We identified patients receiving care at our institution that have undergone multiple surgical procedures for the treatment of hypospadias (mean 3.8 procedures; SD ±1.4) and invited them and their parents to prospectively complete the BASC-2 under an IRB-approved protocol. Psychological health was defined according to norms from the BASC-2. Scores from parent and self-report sub-scales of anxiety, depression, internalizing behaviors, externalizing behaviors, and overall symptoms of psychological distress were collected. Comparisons were made to general population data for age-matched males as provided by the BASC-2.
Four of 12 (33%) participants (mean 10.6 years; range 7-20 years) were rated at or above the at-risk level on the Internalizing Problems composite of the Parent Rating Scale. This finding was significant (p < 0.001) compared to age-matched norms and suggests sufficient psychological distress to warrant monitoring and potential treatment referral.
Preliminary data demonstrated greater psychological risk in patients who have undergone multiple procedures for hypospadias than previously suggested. Our findings support continued data collection, as elevated scores on the Internalizing Problems composite represent risk factors for symptoms related to both anxiety and depression. Such symptoms, if regularly screened, could warrant referral for treatment and better mental health outcomes in patients with complex hypospadias. Findings also suggest that the BASC-2, widely used in psychological assessment, but not in medical settings or pediatric research, may be a more appropriate measure of overall behavior for this population.