Beyond Surgical Repair in Hypospadias: Genetics, Emerging Technologies, and Lifelong Outcomes—A Narrative Review

Abstract

Background/Objectives: Hypospadias is a heterogeneous congenital anomaly. This selected narrative review examines emerging domains that may complement conventional surgical care, with particular emphasis on complex, proximal, atypical, familial, or disorder of sex development (DSD)-associated presentations and on long-term outcomes. Methods: A structured narrative search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for English-language human or clinically applicable translational literature published from January 2000 through December 2025, supplemented by reference screening and targeted updating of genetics, non-operative management, and adult-outcome literature. Results: Objective phenotyping may improve anatomical description and research comparability. Endocrine/genetic evaluation should be considered in proximal hypospadias, including boys with descended testes, and is most clearly indicated when accompanied by cryptorchidism, micropenis, undervirilisation, familial disease, or other features suggestive of DSD; isolated distal hypospadias without such features does not generally require genetic or formal multidisciplinary DSD assessment. Limited evidence also supports explicit consideration of non-operative management in selected mild distal cases, while studies of uncorrected distal hypospadias report heterogeneous functional and cosmetic outcomes. Artificial intelligence (AI), quantitative tissue assessment, registries, and biobanks remain investigational. Long-term studies highlight sexual, reproductive, psychosocial, and late surgical outcomes that may extend into adulthood. Conclusions: The literature supports a selective, phenotype-driven framework rather than a universal multidisciplinary model, with particular attention to complex/atypical disease and lifelong outcome assessment.