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Psychological Functioning In Patients Undergoing Multiple Procedures for Hypospadias: A Prospective Pilot Study of Children and Adolescents
Duncan Seawell, Psy.D., Herbst Katherine, MSc, John Makari, MD, Fernando Ferrer, MD.
Connecticut Children's Medical Center, Hartford, CT, USA.

BACKGROUND:
Published studies of the correlation between hypospadias and risk for psychological distress are inconsistent. A recent systematic review found 13 qualified studies with varying methodologies and inconclusive findings. We sought to obtain prospective pilot data on the psychological adjustment of children who had multiple surgical procedures for hypospadias. No prior study of hypospadias used the Behavior Assessment System for Children, Second Edition (BASC-2), despite strong psychometric properties and advantages over previous instruments. Expanding the current study would be supported by significantly higher prevalence of at-risk or clinical range scores among hypospadias patients.
METHODS:
Patients with multiple hypospadias surgeries (mean 3.8 procedures) were identified and parent and/or self-report forms were completed. Psychological health was defined according to and measured against age-matched norms (BASC-2). Scores were compared across sub-scales of anxiety, depression, and broad indexes of internalizing behaviors, externalizing behaviors, and overall psychological distress.
RESULTS:
4 of 12 (33%) participants (mean 10.6 years; range 7-20 years) were rated at or above the at-risk level for Internalizing Problems on the Parent Rating Scale. This finding was significant (p < 0.001) compared to BASC-2 norms and suggests sufficient psychological distress to warrant monitoring and potential treatment referral.
CONCLUSIONS:
Preliminary data demonstrated greater psychological risk in patients who have undergone multiple procedures for hypospadias than previously suggested. Elevated scores on the Internalizing Problems composite represent risk factors for both anxiety and depression. Such symptoms, if regularly screened, could warrant referral for treatment and better mental health outcomes in patients with complex hypospadias.


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