Comparision of uroflow parameters before and after hypospadias surgery

Abstract

Aim: Uroflow investigation is used to identify whether stenosis has developed in the constituted neourethra after hypospadias repair. It is not clear whether a functional partial stenosis in the urethra in hypospadias cases is related to surgery or is present before the surgery. We aimed to investigate whether the obstructive pattern found in the urethra was related to the surgery or was present previously by performing a uroflow investigation before and after surgery in children operated for hypospadias and also in children with normal urethra as a control group in this study.

Materials and methods: A total of 47 pediatric cases operated on and followed up with a diagnosis of hypospadias at the Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital’s Pediatric Surgery Clinic between January 2010 and June 2013 and a control group of 32 healthy children without symptoms of hypospadias or other urinary system problems were included in the study. Uroflowmetric investigations (maximum urine flow rate, mean urine flow rate, urination amount, urination duration, duration of reaching maximum speed) of the cases before and after surgery and uroflowmetric investigation of the control group together with the residual urine amount as examined by ultrasonography were compared. We evaluated 47 pediatric hypospadias cases in terms of age at surgery, meatus localization, type of surgery, and number of surgeries.

Results: The mean age was 6.1 years for the patients operated with a diagnosis of hypospadias and 7.78 years for the control group. The most common uroflow flow curve in the preoperative study group and the control group was bell-type flow (57.4 and 43.8%). Bell-type flow was again most common postoperatively, but there was a significant decrease in plateau-type flow. Comparison of the uroflowmetry measurements of the hypospadias and control groups showed that the preoperative flow rates were low and some cases had residual urine in the bladder in the first group. When the postoperative measurements were used for the comparison, a significant difference was observed between the hypospadias and control groups in the flow rate and residual urine amount, whereas there was no difference compared with the preoperative evaluation. No significant relationship was found between the type of surgery used and uroflowmeter evaluations in our study.

Conclusion: We found that the urination dynamics and partial urethral obstruction of hypospadias cases were present from the beginning and did not improve with surgery.

Keywords: children, hypospadias, uroflowmetry