Clinical Factors Associated with Anxiety Disorders in Adults with Childhood Hypospadias Repair: Results from the F.R.E.S.H. Study

Objectives: This study aimed to evaluate the prevalence of pathological anxiety and to identify clinical, functional, and surgical factors associated with anxiety disorders in adults who underwent hypospadias repair during childhood. Patients and Methods: This cross-sectional analysis included adult males (≥18 years) previously treated surgically for hypospadias in childhood who underwent clinical evaluation and completed validated questionnaires assessing anxiety (State-Trait Anxiety Inventory, STAI-Y1/Y2), depression (Beck Depression Inventory-II), urological function (uroflowmetry and International Prostate Symptom Score), sexual function, and genital perception. Pathological anxiety was defined as STAI-Y1 ≥ 40. Patients with and without anxiety were compared using univariate analyses, and variables reaching statistical significance were entered into a binary logistic regression model to identify clinical variables independently associated with anxiety. Results: A total of 302 patients who underwent hypospadias surgery between 1975 and 2005 were included in this study. Of the 302 traced patients, 113 (37.4%) were contacted successfully, and a total of 36 adult male patients met the inclusion criteria for this study (mean age at assessment 23.6 years). Pathological anxiety was present in 14 patients (38.9%). Compared with non-anxious individuals, anxious patients were younger at assessment (p = 0.012), showed more impaired voiding dynamics, with lower flow index values (p = 0.060), and reported more severe urinary symptoms (p = 0.050). Depressive symptoms were significantly higher in the anxiety group (BDI-II: 9.5 vs. 3.1; p < 0.001) and were independently associated with pathological anxiety on multivariable analysis (OR 1.84, 95% CI 1.16-2.92; p = 0.01). Postoperative complications were more frequent and more severe among anxious patients, although this did not reach statistical significance. Subjective and objective aesthetic outcomes did not differ between groups. Conclusions: This study demonstrates that anxiety in adults treated for hypospadias during childhood is more closely related to functional urinary impairment, surgical complications, and depressive symptoms than to aesthetic outcomes. These findings emphasise the need for long-term, multidisciplinary follow-up incorporating routine mental health assessment. Early psychological screening and targeted supportive interventions may be associated with better functional and psychosocial outcomes, supporting a holistic, integrated model of care for hypospadias patients.