Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood

Abstract

There is great potential for normalization of urinary flow at puberty for boys with hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable.

Hypospadias, all there is to know

“…Interestingly, normalization of previous abnormal voiding patterns also seems possible. In a study by Andersson et al, normalization of urinary flowmetry at puberty was seen in 95% of children after TIP repair for hypospadias in childhood [1]. Urinary complications (e.g., meatal stenosis, fistula, or urethral stenosis) can still occur years after initial repair, and long-term follow-up is therefore advised [34].…”

Urinary flow rate after TIP urethroplasty for hypospadias

“…3 Whether this observation is relevant and whether the obstructive urinary flow pattern requires correction remains debatable as long-term follow-up data are lacking. 4 Andersson et al 5 evaluated 40 pottytrained boys prospectively from the time of initial TIP surgery, with (n = 23) or without (n = 17) preputioplasty, until puberty. Uroflowmetry results were obtained 1 year and 7 years after surgery, and finally at puberty.…”

“…Some important biases must, however, be noted. Firstly, the surgical procedure was performed in a small group of potty-trained children, 5 despite the fact that the recommended age for such surgery is before the age of 18 months. 6 Secondly, the relatively high complication rate, and the management of these complications, were not discussed by the authors; however, urethral dilatation and clean intermittent catheter ization are not standard treatment for complications of hypospadias in children, nor is preputioplasty recommended with TIP urethroplasty.…”

“…3,7 Andersson et al 5 prefer to use the laws of physics to explain the spontaneous favourable changes in urinary flow pattern they observed with age: with growth, the diameter of the urethra increases, thereby improving the urine outflow.…”

“…9 The findings of Andersson et al 5 indicate that, together with improvements in peak flow (Q max ) seen after puberty (even greater than the 25% increase described in www.nature.com/nrurol NEWS & VIEWS the normal population), flow curve shape also improves, from a shape correlated with obstructive flow to a shape correlated with nonobstructive flow. However, physical growth alone does not seem sufficient to explain that improvement.…”