Portal de Periódicos da CAPES

Long-Term Urethral Function Measured by Uroflowmetry After Hypospadias Surgery: Comparison with an Age Matched Control

2012; Lippincott Williams & Wilkins; Volume: 188; Issue: 4S Linguagem: Inglês

10.1016/j.juro.2012.04.105

1527-3792

Marlon Perera, Brendan C. Jones, Mike O’Brien, John M. Hutson,

Hernia repair and management

No AccessJournal of UrologyHypospadias1 Oct 2012Long-Term Urethral Function Measured by Uroflowmetry After Hypospadias Surgery: Comparison with an Age Matched Control Marlon Perera, Brendan Jones, Mike O'Brien, and John M. Hutson Marlon PereraMarlon Perera Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia , Brendan JonesBrendan Jones Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia , Mike O'BrienMike O'Brien Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia , and John M. HutsonJohn M. Hutson Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Urology Department, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia View All Author Informationhttps://doi.org/10.1016/j.juro.2012.04.105AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Long-term outcomes of hypospadias surgery, particularly urinary function, have not been examined thoroughly. Uroflowmetry can be used to evaluate long-term functional outcomes by assessing flow shape and the rate of micturition. We assessed urethral function using uroflowmetry in adolescents after undergoing hypospadias repair in infancy and compared this with age matched controls. Materials and Methods: After human research ethics committee approval (HREC 28111A), 17 boys 13 to 15 years old with no history of urological or neurological disorders underwent uroflowmetry (65 separate voids) to determine standard values for boys of this age. Then 60 boys age 13 to 15 years who had undergone treatment for hypospadias in early infancy were seen for long-term followup and underwent uroflow assessment. Results: Standard urinary flow rates were established in the 13 to 15-year-old control group and represented on a nomogram. In the boys who underwent hypospadias surgery the urine flow rates were significantly lower compared to the control nomogram (p <0.0001), with half the patients having uroflow rates below 1 SD from the control mean but without symptoms. Boys with significant preoperative chordee were more likely to have poorer urinary flow (p <0.04). A poor urinary flow rate also was significantly associated with post-void residual bladder volume (p <0.03). There was no correlation with original meatal location, number of operations, presence of postoperative complications, current anatomy and lower urinary tract symptoms (eg post-void dribble, hesitancy, incontinence). Conclusions: At long-term followup after hypospadias surgery urinary flow rates were significantly lower compared to age matched controls but still fell within the normal range. In the hypospadias cohort there was no significant association with lower urinary tract symptoms and poor urinary flow. Detection of poor urinary flow may indicate incomplete bladder emptying. The presence of severe chordee preoperatively is a significant risk factor for poor urinary flow rates on long-term followup. References 1 : Hypospadias: anatomy, etiology, and technique. J Pediatr Surg2006; 41: 463. Google Scholar 2 : Lower urinary tract dysfunction and urodynamics in children. Eur Urol2000; 38: 655. Google Scholar 3 : Maximum and average urine flow rates in normal children–the Miskolc nomograms. Br J Urol1995; 76: 16. Google Scholar 4 : Uroflowmetry nomogram in Iranian children aged 7 to 14 years. BMC Urol2005; 5: 3. Google Scholar 5 : Micturition studies in infants and children: Normal urinary flow. Scand J Urol Nephrol1970; 4: 191. Google Scholar 6 : Normal pediatric uroflow rates in a nonclinical setting. J Urol1982; 127: 732. Link, Google Scholar 7 : Age related flow rate nomograms in a normal pediatric population. Acta Urol Belg1989; 57: 457. Google Scholar 8 : Urine flow in childhood: a study of flow chart parameters based on 1,361 uroflowmetry tests. J Urol1997; 157: 1426. Google Scholar 9 : Uroflow nomogram for male adolescents. J Urol2005; 174: 1436. Link, Google Scholar 10 : Urinary flow in healthy schoolchildren. Neurourol Urodyn1994; 13: 281. Google Scholar 11 : Early hypospadias surgery may lead to a better long-term psychosexual outcome. J Urol2009; 182: 1744. Link, Google Scholar 12 : The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology2003; 61: 37. Google Scholar 13 : Non-invasive assessments of pediatric voiding dysfunction. Lower Urin Tract Symptoms2009; 1: 63. Google Scholar 14 : HOSE: an objective scoring system for evaluating the results of hypospadias surgery. BJU Int2001; 88: 255. Google Scholar 15 : The flow rate nomogram: II: Clinical correlation. J Urol1980; 123: 208. Link, Google Scholar 16 : A new recording uroflometer: a simple automatic device for measuring voiding velocity. J Urol1957; 78: 97. Link, Google Scholar 17 : The voiding rates in normal male children. J Urol1959; 82: 224. Link, Google Scholar 18 : Urodynamics. Pediatr Clin North Am1987; 34: 1133. Google Scholar 19 : Pediatric uroflow rate nomograms. J Urol1982; 127: 727. Link, Google Scholar 20 : The flow rate nomogram: I: Development. J Urol1979; 122: 665. Link, Google Scholar 21 : Tubularized incised plate repair: functional outcome after intermediate followup. J Urol2003; 169: 331. Link, Google Scholar 22 : Value of urinary flow patterns in the follow-up of children who underwent Snodgrass operation. Urol Int2007; 78: 245. Google Scholar 23 : Functional evaluation of one-stage urethroplasty with parameatal foreskin flaps repair of hypospadias using uroflowmetry. Int J Urol2003; 10: 297. Google Scholar 24 : Morphology and urodynamics after longitudinal urethral plate incision in proximal hypospadias repairs: long-term results. Eur J Pediatr Surg2004; 14: 35. Google Scholar 25 : Functional characteristics of the reconstructed neourethra after island flap urethroplasty. J Urol1995; 153: 1657. Link, Google Scholar 26 : Urinary flow rates in hypospadias. Br J Plast Surg1997; 50: 530. Google Scholar 27 : Functional evaluation of tubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry. BJU Int2001; 87: 540. Google Scholar 28 : Functional evaluation of the results of hypospadias surgery with uroflowmetry. J Urol1995; 154: 835. Link, Google Scholar 29 : Intermediate-term functional and cosmetic results of the Snodgrass procedure in distal and midpenile hypospadias. Pediatr Surg Int2004; 20: 197. Google Scholar 30 : Assessment of urinary stream after repair of anterior hypospadias by meatoplasty and glanuloplasty. J Urol1985; 134: 100. Link, Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByFine R, Reda E, Zelkovic P, Gitlin J, Freyle J, Franco I and Palmer L (2015) Tunneled Buccal Mucosa Tube Grafts for Repair of Proximal HypospadiasJournal of Urology, VOL. 193, NO. 5S, (1813-1818), Online publication date: 1-May-2015.Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Sillén U and Holmdahl G (2018) Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in ChildhoodJournal of Urology, VOL. 194, NO. 5, (1407-1413), Online publication date: 1-Nov-2015. Volume 188Issue 4SOctober 2012Page: 1457-1462 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.KeywordshypospadiasurodynamicsMetricsAuthor Information Marlon Perera Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia More articles by this author Brendan Jones Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia More articles by this author Mike O'Brien Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia More articles by this author John M. Hutson Douglas Stephens Surgical Research Unit, Murdoch Childrens Research Institute, Melbourne, Australia Urology Department, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia More articles by this author Expand All Advertisement PDF DownloadLoading ...