Importance of urinary flow studies after hypospadias repair: A systematic review

Abstract

A systematic review was performed of publications relating to the results of urinary flow studies after hypospadias repair dating back to 1978, when what appears to be the first publication on this topic was found. The literature search was performed using the key words "hypospadias" combined with "urinary flow", "urine flow", "uroflow", "uroflowmetry", and "long-term". We also reviewed the abstracts and full-length articles cited in the reference list of selected articles. Criteria for inclusion in the present systematic review included descriptions of patient selection, surgical technique, the severity of disease (proximal vs distal), and the method used to determine uroflow, as well as a definition of urethral obstruction. In all, 339 article titles were found. Of these, 25 abstracts appeared relevant and the full text of these articles were reviewed , with 22 of the papers included in this review. Sixteen reports had appeared in the literature since 2001, compared with six between 1978 and 2000, suggesting an increasing interest in this topic. On the basis of the results of the present systematic review, we recommend that asymptomatic children operated on for hypospadias in infancy should have one flow study after toilet training, with that study repeated if the results are abnormal. It appears that early abnormal flows improve spontaneously, so that children operated on after toilet training who are asymptomatic should undergo their first uroflow measurement 1 year after surgery. Children with obstructed flow parameters or borderline flows should be followed until adulthood , until long-term follow up studies clarify the significance of abnormal flow parameters. Given the present findings, we anticipate that in the next two decades urologists will need to treat a number of men with strictures resulting from hypospadias repairs performed in childhood.

“Snodgraft” Technique for the Treatment of Primary Distal Hypospadias: Pushing the Envelope

“…7 Gonzalez and Ludwikowski previously highlighted the importance of this worrisome complication and predicted that urologists will need to treat a number of patients with this problem in the next 2 decades. 8 The incidence has been reported at 4.7% (range 0% to 19%) in the literature. 4 The condition can either be treated with urethrotomy, with dilation or conservatively but it is often unrecognized and thus underdiagnosed.…”

Prospective Randomized Comparison of Distal Extension of Midline Urethral plate Incision and Standard Tubularized Incised Plate Urethroplasty – Do Anatomical Penile Measurements Influence the Outcomes?

“…While some studies claimed that majority of patients exhibited normal flow pattern [14][15][16], others reported an obstructed flow in a significant proportion of cases [17,18]. In a systematic review addressing the importance of uroflowmetry studies after TIP repair, 11 studies reported obstructive flow in 24.6% of patients (93 / 378) [19].…”

“…Uroflow data are depicted in table 2. Using a nomogram for age matched children [8], the Qmax was plotted against the voided volume where 4 out of 28 cases (14.3%) had obstructed flow with a Q-max values below the 5 th percentile on the nomogram, two in each group, that is below than previously reported in the literature [19]. Qmax values in most cases were between 25 th and 50 th percentile of the nomogram while Qave values were above the 5 th percentile (Figure 3 a, b).…”

Is Routine Uroflowmetry Necessary following Hypospadias Repair?

“…Complications post hypospadias repair are well described, with approximately 20% of all comers requiring further surgery [10]. Approximately half will require a further operation within year one, 38% after year two and 5% after year three [8].…”