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PEDIATRIC
UROLOGY
Tubularized
incised plate repair: functional outcome after intermediate followup
Hammouda HM, El-Ghoneimi A, Bagli DJ, McLorie GA, Khoury AE
Division of Urology, The Hospital for Sick Children, Toronto, Ontario,
Canada
J Urol. 2003; 169:331-3
- Purpose:
We describe the functional outcome following tubularized incised plate
repair of hypospadias in toilet trained children after an intermediate
followup.
- Materials
and Methods: Children
were included in this study only if they were toilet trained and had
flow rate data not less than 6 months after primary tubularized incised
plate hypospadias repair or 2 months after any secondary procedure to
correct complications. Uroflow data (peak flow, voided volume and post-void
residuals) were analyzed and plotted on previously determined age-volume
dependent nomograms.
- Results:
Of the 48 boys, 39 required no secondary procedures, while 9 secondary
fistula closures were performed in 2, meatotomy in 2 and dilation in
5. After either primary (n = 26) or secondary (n = 7) procedures 33
of the 48 patients (68.7%) had normal peak flow rate and 15 (31.3%)
had low peak flow rate. Of the 48 patients 46 had post-void residual
urine less than 10% of voided volume.
- Conclusions:
Most children will void efficiently with no straining and no post-void
residual (1/2) to 4 years after tubularized incised plate hypospadias
repair. Of our patients 68.7% have normal peak flow rate. Intermediate
followup of larger series and followup at puberty are recommended to
resolve the debate concerning the long-term functional outcome of tubularized
incised plate hypospadias repair.
- Editorial
Comment
This paper attempts to evaluate the functional outcome of the incised
plate hypospadias repair. In my mind, the data are incomplete; however,
the authors do find that the majority of patients had flow rates below
the mean. Although these data would not yet convince me to give up this
excellent repair, it does give pause and make us ever more aware that
6 month to 4 year followup is very insufficient for pediatric urological
conditions.
Dr.
Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA
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