PURPOSE: Hypospadias repair is commonly performed by pediatric urologists with established complications.
Little is known about the development of recurrent UTIs in patients after hypospadias repair. Herein, we attempt to shed light on this poorly understood topic.
MATERIALS AND METHODS: We retrospectively reviewed records of all patients who had recurrent UTIs following primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. Age, operative 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, 1.91%(43/2249) of boys were diagnosed with recurrent UTIs after hypospadias repair. Mean age at repair was 14 months(6-24). Median follow-up was 6.5 years(1.5-11). Primary TIP and TVIF were performed in 47%(20/43) and 35%(15/43) respectively. Redo surgeries were performed in 18%(8/43). Initial meatal location was proximal in all TVIFs and redo repairs, compared to 1 in the TIP group. Postoperative VCUGs, ultrasounds and DMSA scans were performed in 58%(25/43), 90%(39/43) and 19%(8/43) of patients respectively. Abnormalities were noted. Of those who had a TVIF repair, urethral diverticulae and urethral fistulas were seen in 47%(7/15) each. Conversely, in those who had a TIP repair, elevated PVR and vesicoureteral reflux were more commonly seen in 40%(8/20) and 50%(10/20) of patients respectively.
CONCLUSIONS: The pathophysiology of recurrent UTI is multifactorial however post-operative complications seem to vary with type of procedure. Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomic abnormalities.
Written by:
Wehbi E, Patel P, Kanaroglou N, Tam S, Weber B, Lorenzo A, Salle JL, Bagli D, Koyle M, Farhat WA. Are you the author?
The Hospital for Sick Children and University of Toronto, Ontario, Canada.
Reference: BJU Int. 2013 Jul 25. Epub ahead of print.
doi: 10.1111/bju.12387
PubMed Abstract
PMID: 24053220
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