Endocrine Abstracts

Background/Aims: Hypospadias is one of the most common genital variations, and when proximal or complex, may fall within the spectrum of Differences of Sex Development (DSD). Surgical management in this setting is challenging, with high complication rates and limited long-term outcome data. This study aimed to evaluate management pathways, surgical approaches and outcomes for individuals with DSD and hypospadias managed at a single tertiary centre over two decades.

Methods: A retrospective chart review was conducted of individuals with DSD and hypospadias presenting between 2001–2021. Data collected included phenotype, diagnosis, hormonal and surgical management, complications, and outpatient follow-up.

Results: A total of 206 individuals were identified; 192 underwent hypospadias surgery. Most were diagnosed in the neonatal period (97%). The median External Genitalia Score (EGS) was 7.5, indicating the presence of significant genital variation. Of the 192 who underwent surgery, the median number of hypospadias-related procedures was three (range 1–18). Overall, complications occurred in 63% (n = 121/192), with 55% requiring further procedures for complications such as fistula or meatal stenosis. Rates of complications did not differ between planned single-stage and two-stage repairs overall, though meatal stenosis and epididymo-orchitis were more frequent in the two-stage group. Pre-operative testosterone was used in 27% but was not associated with complication rates. Almost half (49%) of those eligible were lost to follow-up in adolescence.

Discussion: This study highlights the considerable surgical complexity of hypospadias in the context of DSD, with complication rates at the higher end of those reported internationally. The frequency of multiple procedures emphasises the importance of transparent pre-operative counselling and shared decision-making with families. The suboptimal adolescent follow-up also draws attention to the need for structured systems of longitudinal care, given the risk of late complications and the importance of fertility and psychosocial counselling during this life stage. These findings are particularly relevant in the context of international debate about the most appropriate timing of surgery and a global shift towards deferring non-urgent interventions until individuals can participate in decisions about their care.