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S16-4
(PP)
URINARY FLOW RATES AFTER HYPOSPADIAS REPAIR INCREASE DURING
PUBERTY
Nicol BUSH
1
, Gwen GRIMSBY
2
, Carlos VILLANUEVA
3
and Warren SNODGRASS
1
1) PARC Urology, Dallas, USA - 2) Pheonix Children's Hospital, Pheonix, USA - 3) University of Nebraska, Department of
Urology, Omaha, USA
PURPOSE
It was recently published that maximum (Qmax) and average (Qave) flow rates significantly increase during puberty in
normal boys (Gupta et al. JUrol 2013; 190:1008-13). We compared uroflow parameters in hypospadias patients with
prepubertal and pubertal uroflows to determine changes in neourethra function during pubertal growth.
MATERIAL AND METHODS
Uroflowometry was systematically obtained in toilet trained patients following hypospadias repair, with results recorded
prospectively. The database was reviewed to identify those with both prepubertal and pubertal studies, with mean
Qmax, Qave, and voided volumes compared using paired t-tests.
RESULTS
There were 14 patients who underwent 12 TIPs (4 reoperative), 1 reoperative oral graft inlay and 1 primary 2-stage
preputial graft. The meatus was distal in 6 and proximal in 8. Mean age at prepubertal testing was 9 years (4-11),
versus 13 years (10-18) during puberty. Tanner stage during puberty was 2 (n= 5), 3 (n=3), and ≥4 (n=6).
Uroflow parameters significantly increased during pubertal assessment (mean Qmax 9
→
17cc/sec, p=0.001; Qave
6
→
11cc/sec, p=0.003; voided volume 71
→
158cc, p=0.036). While mean Qmax in patients (9pre
→
17cc/sec post-
pubertal) was lower than reported in normal boys (15pre
→
22cc/sec post-pubertal), mean Q ave was similar (6 vs.
8cc/sec prepubertal and 11 vs 11cc/sec postpubertal). No hypospadias patient had obstructive voiding symptoms, and
all post-void residual measurements were<20cc (both pre-pubertal and pubertal). Flow patterns were unchanged in 9,
improved in 2 (plateau to bell), and worsened in 3 despite increases in Qmax (2 bell to plateau, 1 bell to interrupted).
CONCLUSIONS
Qmax and Qave significantly increase during puberty in boys after childhood hypospadias repair, following the same
pattern observed in boys without hypospadias. These data suggest urethral plate and graft urethroplasties behave
similarly to native urethras during puberty. Pubertal status should be reported for better interpretation of uroflow data.