{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:16:03Z","timestamp":1789467363048,"version":"build-2803163510"},"reference-count":42,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Pers. Med.","JPM"],"abstract":"<jats:p>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 (\u226518 years) previously treated surgically for hypospadias in childhood who underwent clinical evaluation and completed validated questionnaires assessing anxiety (State\u2013Trait 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 \u2265 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 &lt; 0.001) and were independently associated with pathological anxiety on multivariable analysis (OR 1.84, 95% CI 1.16\u20132.92; 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.<\/jats:p>","DOI":"10.3390\/jpm16090472","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:16:48Z","timestamp":1789460208000},"page":"472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Factors Associated with Anxiety Disorders in Adults with Childhood Hypospadias Repair: Results from the F.R.E.S.H. Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2495-1938","authenticated-orcid":false,"given":"Michele","family":"Gnech","sequence":"first","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3359-3191","authenticated-orcid":false,"given":"Massimiliano","family":"Buoli","sequence":"additional","affiliation":[{"name":"Department of Neurosciences and Mental Health, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6105-1617","authenticated-orcid":false,"given":"Federica","family":"Fanti","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Paediatric Surgery Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Rotondi","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Paediatric Surgery Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Marceca","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Paediatric Surgery Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"},{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mitzman","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ciamarra","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Garelli","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario Guido","family":"Minoli","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika Adalgisa","family":"De Marco","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Stroppa","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Di Grazia","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Ausl Romagna, Ospedale Infermi, 47923 Rimini, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Taverna","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduje","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Castagnetti","sequence":"additional","affiliation":[{"name":"Pediatric Urology Unit, Bambino Ges\u00f9 Children Hospital and Research Center, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianantonio","family":"Manzoni","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Berrettini","sequence":"additional","affiliation":[{"name":"Department of Paediatric Urology, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore 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