Investigating adult male sexual function and fertility after childhood hypospadias repair surgery – a systematic review

Hypospadias, a congenital condition where the urethral opening is on the ventral of the penis, presents challenges in both diagnosis and treatment. Despite surgical advancements, long-term issues such as psychological distress and concerns about sexual function and fertility persist. Our study aims to systematically review sexual function and fertility outcomes in adults who underwent childhood hypospadias repair surgery, offering insights for clinical practice and future research. This is a systematic review study. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we searched PubMed, Embase, and Scopus using predefined relevant keywords. Quality assessment was conducted using the Newcastle-Ottawa Scale. Among 288 initially identified articles, 14 meet eligibility criteria with a total of 6,737 participants for fertility outcomes and 933 for sexual function outcomes. Overall included study quality was deemed average. Distal hypospadias showed more favorable sexual function and fertility compared to severe cases that may experience issues such as ejaculation problems and infertility. Our review suggests that individuals who underwent childhood urethral repair surgery due to distal type hypospadias have more favorable sexual and reproductive outcomes than proximal hypospadias. However, proximal cases may exhibit suboptimal sexual function due to penile curvature, lower semen quality, and ejaculation function. Further multicentric research is needed to confirm these findings and guide clinical management effectively.