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LONG-TERM FUNCTIONAL OUTCOMES AFTER PENOSCROTAL HYPOSPADIAS
REPAIR: A COMPARATIVE STUDY OF PROXIMAL TIP, ONLAY AND DUCKETT
Pierre-Alain HUEBER, Yann CHAUSSY, Julie FRANC-GUIMOND, Diego BARRIERAS and Anne-Marie HOULE
Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Department of Surgery, Division of Pediatric
Urology, Montreal, CANADA
PURPOSE
The aim of the study was to examine the evolution of urinary function of patients that underwent penoscrotal
hypospadias repair with more than 10 years of follow-up including the adolescent period.
MATERIAL AND METHODS
Cases of hypospadias surgeries performed at our institution between 1997 and 2001 were reviewed selecting patients
that underwent primary penoscrotal repair and with documented uroflowmetry data at postoperative follow-up. Patients
were analyzed according to three types of surgeries: proximal tubularized incised plate (pTIP), Onlay and Duckett
urethroplasty, compared with normal children using nomogram adjusted for age and BSA. All parameters including
Qmax, Voiding Volume (VV), and post-void residual volumes (PVR) were collected prospectively. Comparative analysis
between surgeries was performed at 1,2,3,5,8,11 and 12 years post-operatively
RESULTS
54 patients, 25(48%) pTIP, 18(35%) Onlay, and 9(17%) Duckett met inclusion criteria (median follow-up 10 years).
Overall, during the first 3 years after surgery, Qmax slowly increased from 7.9 to 8.75 ml/. In contrast, Qmax leaped
from 11ml/s at 8 years post-operative to 16.2 ml/s at 12 years post-operative corresponding to the time of puberty
(age≈14y). When plotted against nomogram, 36 to 82% of patients exhibit an obstructive pattern (Qmax<5
th
percentile) at age < 7y. This proportion was higher amongst pTIP (81.8%;p=0.02). However, by age>13y, the majority
of patients normalize their Qmax (87%-100%>5
th
), including for pTIP without detected differences between surgeries
(p=0.72).
CONCLUSIONS
Qmax below normal range is frequent after hypospadias surgeries especially in pTIP patients. However, given the
remarkable improvement seen at puberty in the majority of cases, an active surveillance approach until adolescence is
recommended to prevent unnecessary intervention.