title: Is there a need to do routine sonological, urodynamic study and cystourethroscopic evaluation of patients with simple hypospadias?
abstract: OBJECTIVE
  To study the patients with hypospadias for urinary tract anomalies, bladder functions and the anatomical changes in the urethra, bladder and ureters.
  
  
  METHODS
  65 cases of untreated hypospadias (14 anterior, 46 mid penile, 5 posterior penile) presenting between 1 and 14 years age were evaluated with ultrasonography, urodynamic study, uroflowmetry and intraoperative cystourethroscopy.
  
  
  RESULTS
  Ultrasound showed abnormalities in 12/65 (18.46%) with mild unilateral hydronephrosis in 2, bilateral hydroureteronephrosis in 2, small dysplastic kidney in 1, single kidney in 1, epididymal cyst in 1 and cystitis in 5. Urodynamic study performed in 60/65 (narrow meatus in 5) showed median maximum voiding pressure 32 (8-75) cmH(2)O. The median average and maximum urinary flow rates were 7 (1-19) and 11 (5-28) ml/s, respectively. Normal capacity with normal bladder pressure was seen in 34 children (56.6%). 13 children (21.6%) had large capacity bladder with normal pressure. Two children showed large capacity bladder with high pressure, three showed a large capacity with low pressure and small capacity with high pressure was seen in eight children (13.3%). Detrusor over activity was seen in 28 (46%) patients, 11 of these had meatal stenosis. Cystourethroscopy done in 60 revealed 34 abnormalities in 18 (30%) patients (single ureteric orifice in 1, dilatation of unilateral ureteric unilateral in 3 and bilateral in 2, ectopic ureteric orifice in 2, trabeculated bladder in 8, bladder diverticula in 2, prominent vertical ridges in posterior urethra in 2, annular posterior urethral valve in 1, posterior urethral diverticulum in 1, enlarged prostatic utriculus in 4, mucosal tag at verumontanum in 1, prominent cristae in 3, hypertrophied verumontanum in 3 and a small verumontanum in 1). With the hypospadias repair, VUR (Deflux) and bladder abnormalities were also treated.
  
  
  CONCLUSIONS
  Preoperative ultrasonography, urodynamic study and cystourethroscopy detect associated abnormalities in children with hypospadias, albeit asymptomatic, irrespective of location of meatus.
authors.affiliation: Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Lucky
authors.initials: L
authors.lastname: Gupta
authors.forename: Shilpa
authors.initials: S
authors.lastname: Sharma
authors.forename: Devendra K
authors.initials: DK
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D018666:Ureteroscopy / Q000379:methods*; D014521:Urethra / Q000000981:diagnostic imaging*; D014563:Urodynamics / Q000502:physiology*