How Do Toilet-Trained Kids Void Following Tubularized Incised Plate Repair Of Hypospadias?

Abstract

PURPOSE We report the functional outcome of asymptomatic, toilet trained children following uncomplicated tubularized incised plate (TIP) repair of hypospadias. MATERIAL AND METHODS The records of patients who underwent a TIP repair of hypospadias at the Montreal Children Hospital between April 1997 and September 2007 were reviewed. Patients were included if they were toilet trained, asymptomatic and had flow rate data done more than 1year after TIP. Children with postoperative complications or those who required dilation were excluded. Variables predictive of outcome including the surgeon, the type of hypospadias, the presence of a hypoplastic urethra, reinforcement stitches, spongioplasty and the use of a stent were recorded. Uroflow data (peak flow, voided volume and post-void residuals (PVR) were analyzed and plotted on previously determined age-volume dependent nomograms. RESULTS Fifty-six patients were eligible for the study. Median age at surgery was 1.5 years. Hypospadias was distal penile in 49 (87%) and mid and proximal penile in 7 (13%). Mean follow up was 3±1 years (1–8) years. The uroflow curve was bell shaped in 14 (25%), interrupted in 8 (14%), slightly flattened in 28 (50%) and plateau in 6 (11%). Nomograms showed that 36 (64%) were in the 80th percentile, 11 (20%) were in 95th percentile range and 9 (16%) were plotted below 5th percentile. PVR was > 10% of bladder capacity in 23 (41%). Examining the curve shape, nomograms and PVR data against variables predictive of outcome, did not generate any statistical difference outputs. CONCLUSIONS Although asymptomatic, the majority of children after TIP repair have flattened uroflow curve of whom 41% inefficiently empty their bladders and 16% have peak flow plotted below 5th percentile. The long-term outcome after puberty remains to be determined. We report the functional outcome of asymptomatic, toilet trained children following uncomplicated tubularized incised plate (TIP) repair of hypospadias. The records of patients who underwent a TIP repair of hypospadias at the Montreal Children Hospital between April 1997 and September 2007 were reviewed. Patients were included if they were toilet trained, asymptomatic and had flow rate data done more than 1year after TIP. Children with postoperative complications or those who required dilation were excluded. Variables predictive of outcome including the surgeon, the type of hypospadias, the presence of a hypoplastic urethra, reinforcement stitches, spongioplasty and the use of a stent were recorded. Uroflow data (peak flow, voided volume and post-void residuals (PVR) were analyzed and plotted on previously determined age-volume dependent nomograms. Fifty-six patients were eligible for the study. Median age at surgery was 1.5 years. Hypospadias was distal penile in 49 (87%) and mid and proximal penile in 7 (13%). Mean follow up was 3±1 years (1–8) years. The uroflow curve was bell shaped in 14 (25%), interrupted in 8 (14%), slightly flattened in 28 (50%) and plateau in 6 (11%). Nomograms showed that 36 (64%) were in the 80th percentile, 11 (20%) were in 95th percentile range and 9 (16%) were plotted below 5th percentile. PVR was > 10% of bladder capacity in 23 (41%). Examining the curve shape, nomograms and PVR data against variables predictive of outcome, did not generate any statistical difference outputs. Although asymptomatic, the majority of children after TIP repair have flattened uroflow curve of whom 41% inefficiently empty their bladders and 16% have peak flow plotted below 5th percentile. The long-term outcome after puberty remains to be determined.