Objectives: Hypospadias is one of the most common congenital malformations of the male genitourinary system, and postoperative complications remain a major concern affecting surgical outcomes and patients‘ quality of life. Whether machine learning models can effectively predict complication risk using routinely available clinical variables remains unclear. Methods: A retrospective analysis was performed on 671 hypospadias patients who underwent urethroplasty at the Department of Urology, Capital Children’s Medical Center, between December 2015 and September 2024. The final dataset included 671 patients (training set: 536; validation set: 135). The median follow-up duration was 48 months (range: 19 to 72 months). Least absolute shrinkage and selection operator (LASSO) regression with nested cross-validation within the training set was used for feature selection, followed by the development of five machine learning models (Random Forest, XGBoost, LightGBM, Logistic Regression, and Support Vector Machine). Model performance was evaluated using AUC, calibration curves, Brier score, and decision curve analysis. Feature importance was assessed using SHapley Additive exPlanations (SHAP). Results: LASSO retained four features for model development: hypospadias type, surgical technique, surgeon experience, and patient age. The overall complication rate was 22.9% (154/671). Among the models evaluated, the Support Vector Machine (SVM) showed the most balanced performance in the validation set, achieving an AUC of 0.810 and a Brier score of 0.157. LightGBM demonstrated comparable performance (AUC: 0.802). SHAP analysis identified surgical technique as the most influential predictor, followed by surgeon volume and hypospadias type, though these findings should be interpreted with caution given the confounding between surgical complexity and disease severity. Conclusions: An interpretable SVM-based prediction model was developed and internally validated to stratify risk for postoperative complications after hypospadias repair using routinely available clinical variables. SHAP provided clinicians with visual insights into key risk-associated factors. However, given the single-center retrospective design and lack of external validation, further multicenter prospective studies are warranted to confirm the generalizability of these findings before clinical implementation.

Objectives: Hypospadias is one of the most common congenital malformations of the male genitourinary system and is frequently accompanied by other congenital anomalies. Whether patients with associated malformations exhibit distinct endocrine characteristics remains unclear. Methods: A retrospective analysis was performed on 323 hypospadias patients who underwent surgery at Capital Medical University Affiliated Capital Children’s Medical Center between January 2020 and September 2024. Data on surgical age, clinical classification, associated malformations, and sex hormone levels were collected. Propensity score matching was used for between-group comparisons. Results: Associated malformations were present in 68 of 323 patients (21.05%), most commonly involving the urogenital system (75.00%). Cryptorchidism was the most common associated anomaly. The surgical age was significantly later in patients with associated malformations (median 3.34 years) compared to those with isolated hypospadias (2.42 years). Following matching, patients with urogenital-related anomalies had significantly elevated FSH and PRL levels (both p < 0.05) compared with isolated hypospadias, whereas no significant hormonal differences were found in those with non-urogenital anomalies. Conclusions: Children with hypospadias and associated urogenital anomalies exhibited subtle differences in endocrine profiles compared with isolated hypospadias. These findings suggest that hypospadias with urogenital anomalies may represent a clinically distinct subgroup and support the need for further prospective studies and long-term endocrine follow-up.