Long-term functional outcomes of distal hypospadias repair: A single center retrospective comparative study of TIPs, Mathieu and MAGPI

• Published in: Journal of pediatric urology 2015-04, Vol.11 (2), p.68.e1-68.e7
• Main Authors: Hueber, Pierre-Alain, Antczak, Carina, Abdo, Ala, Franc-Guimond, Julie, Barrieras, Diego, Houle, Anne-Marie
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Chi-Square Distribution; Child; Child, Preschool; Cohort Studies; Follow-Up Studies; Humans; Hypospadias; Hypospadias - diagnosis; Hypospadias - surgery; Infant; Male; Monitoring, Physiologic - methods; Pediatrics; Prostheses and Implants; Reconstructive Surgical Procedures - methods; Recovery of Function; Retrospective Studies; Risk Assessment; Sex Factors; Time Factors; Treatment Outcome; Tubularized incised-plate urethroplasty (TIP); Urethra - abnormalities; Urethra - surgery; Urodynamics - physiology; Uroflowmetry; Urologic Surgical Procedures, Male - adverse effects; Urologic Surgical Procedures, Male - instrumentation; Urologic Surgical Procedures, Male - methods; Urology
• ISSN: 1477-5131; 1873-4898
• DOI: 10.1016/j.jpurol.2014.09.011

Summary Introduction Tubularized Incised-Plate (TIP) urethroplasty is currently the preferred technique for distal hypospadias repair. Nevertheless, concerns have been raised on the long-term functionality of the reconstructed neourethra. Objective The aim of this study is to evaluate long-term uroflowmetry parameters' evolution after TIP surgery over a long-term follow-up including the adolescent period. TIP patients were compared to normal children using established Miskolc nomograms, as well as to patients who underwent Mathieu and Meatal Advancement and Glanuloplasty (MAGPI) surgery repairs for distal hypospadias. Study design Files from patients who underwent primary distal hypospadias repair at our institution between January 1, 1997 and January 31, 2001 were reviewed. Only patients with documented serial postoperative uroflowmetry profiles at follow-up visits were included. Comparison between surgeries (TIP vs. Mathieu vs. MAGPI) was performed according to the following postoperative time interval endpoints: 0–6 months, 6–12 months, 12–24 months, 24–48 months, 4–6 years, 6–10 years and >10 years. Maximal urinary flow rate (Qmax) in relation to Voiding Volume (VV) adjusted for Age or Body Surface Area (BSA) were also evaluated in comparison to normal children using established Miskolc nomograms and compared between surgery techniques. Results 153 patients met the inclusion criteria: 70 (43%) TIP, 24 (17%) Mathieu and 59 (35%) MAGPI. Overall, Qmax increases progressively according to time and age and in particular during the period covering adolescence with a similar trend regardless of the type of surgery. Uroflowmetry profiles in terms of Qmax, VV and PVR were equivalent between surgeries at each examined time point. At 10 years of follow-up postopertively, mean Qmax were 17.2 ml/s, 18.8 ml/s and 21.6 ml/s respectively with no significant difference detected between groups (p = 0.344). Compared to normal children when adjusted for voiding volume and BSA, the proportion of obstructive uroflowmetry patterns defined as Qmax< 5th percentile of nomograms was more prevalent in patients aged 2–7 years old at 60% but decreased to less than 10%in patients aged >13 years for all procedures combined (see abstract figure) but without detected differences between surgery types (p = 0.276). Discussion After sub-optimal obstructive maximal urinary flows in the early postoperative period, hypospadias patients treated with TIP exhibit favourable long-term evolution