MP65-08 DIFFICULTIES IN LONG-TERM FOLLOW-UP AFTER SURGERY FOR DISTAL HYPOSPADIAS: A REALITY THAT EXCEEDS OUR EXPECTATIONS!

Abstract

You have accessJournal of UrologyPediatrics: Hypospadias and Penile Surgery (MP65)1 Apr 2020MP65-08 DIFFICULTIES IN LONG-TERM FOLLOW-UP AFTER SURGERY FOR DISTAL HYPOSPADIAS: A REALITY THAT EXCEEDS OUR EXPECTATIONS! Leopold A. Azakpa, Liza Ali, Matthieu Peycelon*, Anthony Kallas-Chemaly, Goharig Enezian, Yves Aigrain, Christine Grapin-Dagorno, Pascale Philippe-Chomette, Annabel Paye-Jaouen, and Alaa El Ghoneimi Leopold A. AzakpaLeopold A. Azakpa More articles by this author , Liza AliLiza Ali More articles by this author , Matthieu Peycelon*Matthieu Peycelon* More articles by this author , Anthony Kallas-ChemalyAnthony Kallas-Chemaly More articles by this author , Goharig EnezianGoharig Enezian More articles by this author , Yves AigrainYves Aigrain More articles by this author , Christine Grapin-DagornoChristine Grapin-Dagorno More articles by this author , Pascale Philippe-ChomettePascale Philippe-Chomette More articles by this author , Annabel Paye-JaouenAnnabel Paye-Jaouen More articles by this author , and Alaa El GhoneimiAlaa El Ghoneimi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000940.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evaluating the outcomes of distal hypospadias surgery for a better standard of care requires long-term follow-up (FU). The aim of this study was to report adherence to a FU protocol and to analyze underlying challenges of long-term FU by evaluating long-term complications. METHODS: A retrospective study identified all patients operated upon for a distal hypospadias by 5 surgeons (2002-2010). The standard protocol for follow-up protocol was a clinical examination at 1 month after surgery, at 1 year, after being toilet-trained, and every 5 years until puberty. Uroflowmetry was performed at every visit after being toilet trained. All children who missed at least one visit were contacted by phone or mail for a new visit. The primary outcome was adherence to the FU protocol. Non-parametric tests were used for statistical analysis. RESULTS: A total of 345 children were included in the study. The median age at surgery was 14 months (5 months–13 years). Ventral couverture and penile torsion were identified in 36.3% and 11.4% respectively. 149 (43.2%) patients had a FU of less than 1 year. 40 (11.6%) patients never returned to clinic after surgery. 196 (56.8%) and 87 (25.2%) patients had a FU at 1 and 5 years without requiring to reschedule an appointment. A total of 226 children were contacted and 58 (25.7%) of these subsequently returned for a clinical exam. When accounting for all FUs, 239 (69.3%) and 123 (35.7%) patients had a check-up at 1 and 5 years. Surgical procedures included tubularized incised plate urethroplasty (TIPU) in 142 (59.4%) children and Thiersch-Duplay urethroplasty in 84 (35.1%). Median FU was 5.5 years (1-14). At puberty, 6 (1.7%) came spontaneously at the clinic and 51 (14.8%) after being called and mailed. We did not identify risk factors to stop being followed-up. The urethral complication rate was 15.9% (38/239) (10.0% fistula, 4.6% stenosis) at 5 years with 54% identified after 1 year of FU. Initial perioperative evaluation (type penile curvature and torsion), surgical procedure, and experience of the pediatric urologist were not identified as a risk factor for urethral complications (overall, fistula and stenosis respectively). CONCLUSIONS: Postoperative FU after distal hypospadias surgery is a challenge. The difficulties of following children who undergo a surgery for distal hypospadias are real. Standardizing postoperative FU is necessary. Expressing the risk of complications to families is critical. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e976-e976 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leopold A. Azakpa More articles by this author Liza Ali More articles by this author Matthieu Peycelon* More articles by this author Anthony Kallas-Chemaly More articles by this author Goharig Enezian More articles by this author Yves Aigrain More articles by this author Christine Grapin-Dagorno More articles by this author Pascale Philippe-Chomette More articles by this author Annabel Paye-Jaouen More articles by this author Alaa El Ghoneimi More articles by this author Expand All Advertisement PDF downloadLoading ...