title: Normalized Urinary Flow at Puberty after Tubularized Incised Plate Urethroplasty for Hypospadias in Childhood.
abstract: OBJECTIVE
  An obstructive urinary flow pattern is frequently seen after tubularized incised plate urethroplasty for hypospadias. However, the significance of this finding has not been determined and long-term results are few. We describe postoperative long-term uroflowmetry results after puberty in males who underwent tubularized incised plate urethroplasty in childhood.
  
  
  METHODS
  A total of 126 boys underwent tubularized incised plate urethroplasty for distal penile to mid shaft hypospadias at Queen Silvia Children's Hospital in Gothenburg between 1999 and 2003. Of the patients 48 were toilet trained at surgery. We report on 40 patients who had data available at 2 and 12 months postoperatively, 7 years postoperatively and at puberty (median age 15.0 years, range 13.7 to 17.1). Of the patients 31 had distal and 9 had mid penile hypospadias. Clinical examination, urinary medical history, uroflowmetry and ultrasound measuring residual urine were performed. Maximum urinary flow was correlated to age and voided volume, using Miskolc nomograms for comparison of percentiles.
  
  
  RESULTS
  At 1 year postoperatively 15 boys (37.5%) had normal urinary flow (above 25th percentile), compared to 16 (40%) at 7 years and 38 (95%) at puberty (p <0.0001). Improvement was significant in patients with distal (p <0.0001) and mid penile hypospadias (p = 0.008), as well as in patients who did (p = 0.0078) and did not undergo intervention (p <0.0001). During followup 5 patients underwent meatotomy due to obstructive symptoms and 4 underwent dilation. Three of these 9 patients had lichen sclerosus.
  
  
  CONCLUSIONS
  There is great potential for normalization of urinary flow at puberty for boys with hypospadias treated with tubularized incised plate urethroplasty. Unless symptoms occur, a conservative approach seems preferable.
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Andersson
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Monika
authors.initials: M
authors.lastname: Doroszkiewicz
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Arfwidsson
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Abrahamsson
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén
authors.affiliation: Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; Pediatric Uro-Nephrologic Center, Department of Pediatric Surgery, Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Gundela
authors.initials: G
authors.lastname: Holmdahl
mesh_terms: D000293:Adolescent; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D011184:Postoperative Period; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D011627:Puberty; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014524:Urethral Obstruction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics / Q000502:physiology*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: follow-up studies; hypospadias; puberty; urethral obstruction; urination