Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair.
OBJECTIVE
To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair.


METHODS
We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. Data on age, operating details, postoperative complications and imaging studies were collected. We attempted to identify risk factors for recurrent UTIs after hypospadias repair.


RESULTS
During the study period, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years. Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs. Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted. Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively.


CONCLUSIONS
The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure. Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities.
The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Elias
E
Wehbi
Premal
P
Patel
Niki
N
Kanaroglou
Stephanie
S
Tam
Bryce
B
Weber
Armando
A
Lorenzo
Joao Luiz
JL
Pippi Salle
Darius
D
Bagli
Martin
M
Koyle
Walid A
WA
Farhat
D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods
UTI; hypospadias; paediatrics; urinary tract infection