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Evaluation of urethral structure after hypospadias surgery with uroflowmetry

Yıl 2018, Cilt: 8 Sayı: 4, 291 - 294, 31.12.2018
https://doi.org/10.16899/gopctd.408192

Öz

Aims:

Uroflowmetry is a
simple, noninvasive, easy to use and objectively interpretable urodynamic
study. Uretral stenosis is the most common late complication after hypospadias
surgery. The aim of this study was to evaluate the possible postoperative
meatal stenosis in patients who were operated for hypospadias in our clinic
with uroflowmetry.

Material
and Methods:

The patients with
hypospadias operated in our clinic between January 2015 and January 2017 were
determined as our study group.Uroflowmetry and urine flow measurements were
performed at least two months after the operation. After uroflowmetry
measurement, the residual urine volume was measured by ultrasound device in
pediatric surgery clinic. The estimated bladder volumes were calculated
according to the age of the patients.

Results:

The median age of the
patients was 7.5 (3-14). In the postoperative period, 9 (19.5%) of the patients
had complaints of narrow urination and urination as a clinical complaint. No
statistically significant difference was found between the two groups in terms
of uroflowmetry results, maximum flow rate, time to reach maximum flow rate,
total urine flow time, mean flow rate and residual urine volume (p> 0.005).Sixteen
patients (25.4%) in the postoperative group were smaller than <-2SD
according to the Siroky nomogram and were in the obstruction group.

Conclusions:















Uroflowmetry is an
easy-to-use noninvasive test used to assess early obstruction and to diagnose a
urethral stricture following hypospadias surgery. When compared with the
literature, the maximum flow rate in uroflowmetry measurements is less than 10
ml / s, the average flow rate is low, the voiding curve is the plateau curve and
the five-percentile according to the nomograms and the voiding curve smaller
than -2 SD results are evaluated in terms of urethral obstruction and urethral
dilatation planning is important.

Kaynakça

  • 1. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol1994;151:464-5.2. Beleza-Meireles A, Omrani D, Kockum I, Frisén L, Lagerstedt K, Nordenskjöld A.Polymorphisms of estrogen receptor beta gene are associated with hypospadias. J EndocrinolInvest2006;29:5-10.3. Beleza-Meireles A, Töhönen V, Söderhäll C, Schwentner C, Radmayr C, Kockum I, et al.Activating transcription factor 3:a hormone responsive gene in the etiology of hypospadias.Eur J Endocrinol 2008;158:729-39.4. Sheldon CA, Duckett JW. Hypospadias. Pediatr Clin North Am 1987;34:1259-72.5. Mouriquand PD,Persad R,Sharma S. Hypospadias repair:current principles and procedures.Br J Urol 1995;76:9-22.6. Sauvage P, Becmeur F, Geiss S, Fath C. Transverse mucozal preputial flap for repair ofsevere hypospadias and isolated chordee without hypospadias: A 350-case experience. JPediatr Surg 1993;28:435-8.8. Barcat J. Current Concepts of Treatment. Boston: Little,Brown.1973.7. Borer JG,Bauer SB, Peters CA, et al: Tubularized ,incised plate urethroplasty:Expended usein primary and repeat surgery for hypospadias. J Urol 2001;165:581-5.9. Smulian JC, Scorza WE, Guzman ER, Ranzini AC, Vintzileos AM. Prenatal sonographicdiagnosis of midshaft hypospadias. Prenat Diagn 1996;16:276-80.10.Devesa R,Munoz A,Torrents M, et al. Prenatal diagnosis of isolated hypospadias. PrenatDiadn 1998;18:779-88.11.Husmann DA, Rathbun SR. Long-term followup of visual internalurethrotomy for management of short (less than 1 cm) penile urethral strictures followinghypospadias repair. J Urol 2006;176:1738-41.12.Brannen GE: Meatal reconstruction. J Urol 1976;116:319-21.13. Siroky, M.B. 1990. Interpretation of Urinary Flow Rates. Urol. Clin. North Am.Aug;17(3):537-42.14. Abdelmagid, M. E. and Gajewski, J. B. 1998. Critical Rewiev of the Uroflowmetry,Canadian Journal of Urology. 5(2):569-575.15. Ather, M.H. and Memon, A. 1998. Uroflowmetry and Evaluation of Voiding Disorders.Techniques Urology. 4(3):111-7.16. Abrams, P. 2003. Urodynamics Second Edition. Springer Publishing, 352p. Great Britain.17.Tanagho, E.A. and McAninch J.W. 2003. Smith’s General Urology, 16th Edition. McGrawHill/Appleton &Lange, 830p., SanFrancisco.18. Ding, Y.Y., Lien, P.K. and Choo, P.W. 1998. Use of the Uroflow Study in the Diagnosis ofBladder Outlet Obstruction in Elderly Men. Med J Malaysia. 53(3):209-16.19. Siroky, M.B., Olsson, C.A. and Krane, R.J. 1979. The flow rate nomogram: I. Development.J Urol.Nov;122(5) : 665-8.20. Haylen, B.T., Parys, B.T., Anyaegbunam, W.I., Ashby, D. and West, C.R. 1990. Urine flowrates in male and female urodynamic patients compared with the Liverpool nomograms. Br JUrol. 1990 May;65(5):483-7.21. Siroky, M.B. 1990. Interpretation of Urinary Flow Rates. Urol. Clin. North Am.Aug;17(3):537-42.22. Abdelmagid, M. E. and Gajewski, J. B. 1998. Critical Rewiev of the Uroflowmetry,Canadian Journal of Urology. 5(2):569-575.23. Ather, M.H. and Memon, A. 1998. Uroflowmetry and Evaluation of Voiding Disorders.Techniques Urology. 4(3):111-7.24. McClelland, J.L. and Rumelhart, D.E. 1986. Parallel Distributed Processing: Explorationsin the Microstructure of Cognition. The MIT Press.25. Mattsson, S., Lindstrom, S.: Diuresis and voiding pattern in healthy schoolchildren. Br JUrol, 76: 783, 199526.Elser DM, Wyman JF, McClish DK, Robinson D, Fantl JA, Bump RC. The effect of bladdertraining, pelvic floor muscle training, or combination training on urodynamic parameters withurinary incontinence. Continence Program for Research Group. Neurourol Urodyn1999;18:427e36.27. Belman AB: Hypospadias; in Welch KJ, Randolph JG, Ravitch MM, O’Neill JA, Rowe MI(eds): Pediatric Surgery29.Van der Werff JFA, Boeve E, Bruse` CA, van der Meulen JC. Urodynamic evaluation ofhypospadias repair. J Urol 1997; 157: 1344–630.Neve´us T, von Gontard A, Hoebeke P, Hja¨lma°s K, Bauer S,Bower W, et al. Thestandardization of terminology of lower urinary tract function in children and adolescents:report from the standardisation committee of the International Children’s Continence Society.J Urol 2006;176:314e24.31.Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardisation of terminology oflower urinary tract function. The International Continence Society Committee onStandardisation of Terminology. Scand J Urol Nephrol 1998;114:5e19.32. Kaufman JJ: A new recording uroflometer: asimple automatic device for measuringvoidingvelocity. J Urol 1957; 78: 97.33. Scott R Jr and McIlhaney JS: The voiding rates in normal male children. J Urol 1959; 82:224.34. Malyon AD, Boorman JG, Bowley N. Urinary flow rates in hypospadias. Br JPlast Surg. 1997 Oct;50(7):530-5. PubMed PMID: 9422951.35. Kajbafzadeh, A. M., Yazdi, C. A., Rouhi, O. et al.: Uroflowmetry nomogram in Iranianchildren aged 7 to 14 years. BMC Urol, 5: 3, 200536. Malyon AD, Boorman J, Bowley N. Urinary flow rates inhypospadias. Br. J. Plast. Surg.1997; 50: 530–5.37. Jayanthi V, Mclorie GA, Khjoury AE et al. Functional characteristics of the reconstructedneourethra after island flap urethroplasty. J. Urol. 1995; 153: 1657–9.38. Tuygun C, Bakirtas H, Gucuk A et al. Uroflow findings in older boys with tubularizedincised-plate urethroplasty. Urol. Int. 2009; 82: 71–6.39. Garibay JT, Reid C, Gonzalez R. Functional evaluation of the results of hypospadias surgerywith uroflowmetry. J. Urol. 1995; 154: 835–6.40. Tuygun C, Bakirtas H, Gucuk A, Cakici H, Imamoglu A. Uroflow findings inolder boys with tubularized incised-plate urethroplasty. Urol Int. 2009;82(1):71-6. Epub 2009Jan 20. PubMed PMID: 19172101.41. Hammouda HM, El-Ghoneimi A, Bagli DJ et al.Tubularized incised plate repair: functionaloutcome after intermediate followup. J. Urol. 2003; 169: 331–3.42. Wolffenbuttel KP, Wondergem N, Hoefnagels JJS et al.Abnormal urine flow in boys withdistal hypospadias before and after correction. J. Urol. 2006; 176: 1733–7.43. Scarpa MG, Castagnetti M, Berrettini A et al. Urinary function after Snodgrass repair ofdistal hypospadias:comparison with the Mathieu repair. Pediatr. Surg. Int. 2010; 26: 519–22.44. Braga LH, Pippi Salle JL, Lorenzo AJ et al. Comparative analysis of tubularized incisedplate versus onlay island flap urethroplasty for penoscrotal hypospadias. J. Urol. 2007; 178:1451–7.45. Burgu B, Aydogdu O, Söylemez H et al. Both dorsal and ventral flaps can be used inpreviously circumcised hypospadic adults with comparable success rates. Int. Urol.Nephrol.2010; 42: 689–95.46. Marte A, Di Iorio G, De Pasquale M, Cotrufo AM, Di Meglio D. Functional evaluation oftubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry. BJUInt. 2001 Apr;87(6):540-3. PubMed PMID: 11298053.47. Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G.Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolvespontaneously? J Pediatr Urol. 2011 Aug;7(4):441-5. Epub 2010 Jul 13. PubMed PMID:20630805.

Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi

Yıl 2018, Cilt: 8 Sayı: 4, 291 - 294, 31.12.2018
https://doi.org/10.16899/gopctd.408192

Öz

Bu
çalışmanın amacı hipospadiaslı olgularda eşlik edebilecek alt üriner sistem
obstruksiyonunu üroflowmetri ile değerlendirmek ve bu durumun klinik önemini
vurgulamaktır. Kliniğimizde Ocak 2012 - Ocak 2013 tarihleri arasında takip ve
tedavisi yapılan hipospadiaslı olguların idrarını tutabilen yaş grubunda olan
ve ailesinin işleme yazılı onam verdiği 63 hastaya, ameliyat öncesi poliklinik
değerlendirmede ve ameliyat sonrası dönemde eşlik eden alt üriner sistem
obstruksiyonu değerlendirmek için üroflowmetri ile idrar akış ölçümleri
yapıldı.Tüm hastaların işeme akım eğrisi paternleri tek tek incelendi.
Literatüre uygun olarak azami akış hızı, ortalama akış hızı, azami akışa ulaşma
süresi, idrar akış süresi, idrar boşaltma süresi, işeme sonrası rezidü idrar miktarı
ve işeme eğrisi özelliği ameliyat öncesi ve ameliyat sonrası yapılan
üroflowmetri test sonuçları ile karşılaştırıldı.Üroflowmetrinin orta ve uzun
vadede hipospadias cerrahisi açısından üretral stenozun ve eşlik eden alt
üriner sistem obstruksiyonun erken tanınmasında önemli, ucuz, kolay
uygulanabilen non invaziv bir test oldugu düşünülmektedir.

Kaynakça

  • 1. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol1994;151:464-5.2. Beleza-Meireles A, Omrani D, Kockum I, Frisén L, Lagerstedt K, Nordenskjöld A.Polymorphisms of estrogen receptor beta gene are associated with hypospadias. J EndocrinolInvest2006;29:5-10.3. Beleza-Meireles A, Töhönen V, Söderhäll C, Schwentner C, Radmayr C, Kockum I, et al.Activating transcription factor 3:a hormone responsive gene in the etiology of hypospadias.Eur J Endocrinol 2008;158:729-39.4. Sheldon CA, Duckett JW. Hypospadias. Pediatr Clin North Am 1987;34:1259-72.5. Mouriquand PD,Persad R,Sharma S. Hypospadias repair:current principles and procedures.Br J Urol 1995;76:9-22.6. Sauvage P, Becmeur F, Geiss S, Fath C. Transverse mucozal preputial flap for repair ofsevere hypospadias and isolated chordee without hypospadias: A 350-case experience. JPediatr Surg 1993;28:435-8.8. Barcat J. Current Concepts of Treatment. Boston: Little,Brown.1973.7. Borer JG,Bauer SB, Peters CA, et al: Tubularized ,incised plate urethroplasty:Expended usein primary and repeat surgery for hypospadias. J Urol 2001;165:581-5.9. Smulian JC, Scorza WE, Guzman ER, Ranzini AC, Vintzileos AM. Prenatal sonographicdiagnosis of midshaft hypospadias. Prenat Diagn 1996;16:276-80.10.Devesa R,Munoz A,Torrents M, et al. Prenatal diagnosis of isolated hypospadias. PrenatDiadn 1998;18:779-88.11.Husmann DA, Rathbun SR. Long-term followup of visual internalurethrotomy for management of short (less than 1 cm) penile urethral strictures followinghypospadias repair. J Urol 2006;176:1738-41.12.Brannen GE: Meatal reconstruction. J Urol 1976;116:319-21.13. Siroky, M.B. 1990. Interpretation of Urinary Flow Rates. Urol. Clin. North Am.Aug;17(3):537-42.14. Abdelmagid, M. E. and Gajewski, J. B. 1998. Critical Rewiev of the Uroflowmetry,Canadian Journal of Urology. 5(2):569-575.15. Ather, M.H. and Memon, A. 1998. Uroflowmetry and Evaluation of Voiding Disorders.Techniques Urology. 4(3):111-7.16. Abrams, P. 2003. Urodynamics Second Edition. Springer Publishing, 352p. Great Britain.17.Tanagho, E.A. and McAninch J.W. 2003. Smith’s General Urology, 16th Edition. McGrawHill/Appleton &Lange, 830p., SanFrancisco.18. Ding, Y.Y., Lien, P.K. and Choo, P.W. 1998. Use of the Uroflow Study in the Diagnosis ofBladder Outlet Obstruction in Elderly Men. Med J Malaysia. 53(3):209-16.19. Siroky, M.B., Olsson, C.A. and Krane, R.J. 1979. The flow rate nomogram: I. Development.J Urol.Nov;122(5) : 665-8.20. Haylen, B.T., Parys, B.T., Anyaegbunam, W.I., Ashby, D. and West, C.R. 1990. Urine flowrates in male and female urodynamic patients compared with the Liverpool nomograms. Br JUrol. 1990 May;65(5):483-7.21. Siroky, M.B. 1990. Interpretation of Urinary Flow Rates. Urol. Clin. North Am.Aug;17(3):537-42.22. Abdelmagid, M. E. and Gajewski, J. B. 1998. Critical Rewiev of the Uroflowmetry,Canadian Journal of Urology. 5(2):569-575.23. Ather, M.H. and Memon, A. 1998. Uroflowmetry and Evaluation of Voiding Disorders.Techniques Urology. 4(3):111-7.24. McClelland, J.L. and Rumelhart, D.E. 1986. Parallel Distributed Processing: Explorationsin the Microstructure of Cognition. The MIT Press.25. Mattsson, S., Lindstrom, S.: Diuresis and voiding pattern in healthy schoolchildren. Br JUrol, 76: 783, 199526.Elser DM, Wyman JF, McClish DK, Robinson D, Fantl JA, Bump RC. The effect of bladdertraining, pelvic floor muscle training, or combination training on urodynamic parameters withurinary incontinence. Continence Program for Research Group. Neurourol Urodyn1999;18:427e36.27. Belman AB: Hypospadias; in Welch KJ, Randolph JG, Ravitch MM, O’Neill JA, Rowe MI(eds): Pediatric Surgery29.Van der Werff JFA, Boeve E, Bruse` CA, van der Meulen JC. Urodynamic evaluation ofhypospadias repair. J Urol 1997; 157: 1344–630.Neve´us T, von Gontard A, Hoebeke P, Hja¨lma°s K, Bauer S,Bower W, et al. Thestandardization of terminology of lower urinary tract function in children and adolescents:report from the standardisation committee of the International Children’s Continence Society.J Urol 2006;176:314e24.31.Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardisation of terminology oflower urinary tract function. The International Continence Society Committee onStandardisation of Terminology. Scand J Urol Nephrol 1998;114:5e19.32. Kaufman JJ: A new recording uroflometer: asimple automatic device for measuringvoidingvelocity. J Urol 1957; 78: 97.33. Scott R Jr and McIlhaney JS: The voiding rates in normal male children. J Urol 1959; 82:224.34. Malyon AD, Boorman JG, Bowley N. Urinary flow rates in hypospadias. Br JPlast Surg. 1997 Oct;50(7):530-5. PubMed PMID: 9422951.35. Kajbafzadeh, A. M., Yazdi, C. A., Rouhi, O. et al.: Uroflowmetry nomogram in Iranianchildren aged 7 to 14 years. BMC Urol, 5: 3, 200536. Malyon AD, Boorman J, Bowley N. Urinary flow rates inhypospadias. Br. J. Plast. Surg.1997; 50: 530–5.37. Jayanthi V, Mclorie GA, Khjoury AE et al. Functional characteristics of the reconstructedneourethra after island flap urethroplasty. J. Urol. 1995; 153: 1657–9.38. Tuygun C, Bakirtas H, Gucuk A et al. Uroflow findings in older boys with tubularizedincised-plate urethroplasty. Urol. Int. 2009; 82: 71–6.39. Garibay JT, Reid C, Gonzalez R. Functional evaluation of the results of hypospadias surgerywith uroflowmetry. J. Urol. 1995; 154: 835–6.40. Tuygun C, Bakirtas H, Gucuk A, Cakici H, Imamoglu A. Uroflow findings inolder boys with tubularized incised-plate urethroplasty. Urol Int. 2009;82(1):71-6. Epub 2009Jan 20. PubMed PMID: 19172101.41. Hammouda HM, El-Ghoneimi A, Bagli DJ et al.Tubularized incised plate repair: functionaloutcome after intermediate followup. J. Urol. 2003; 169: 331–3.42. Wolffenbuttel KP, Wondergem N, Hoefnagels JJS et al.Abnormal urine flow in boys withdistal hypospadias before and after correction. J. Urol. 2006; 176: 1733–7.43. Scarpa MG, Castagnetti M, Berrettini A et al. Urinary function after Snodgrass repair ofdistal hypospadias:comparison with the Mathieu repair. Pediatr. Surg. Int. 2010; 26: 519–22.44. Braga LH, Pippi Salle JL, Lorenzo AJ et al. Comparative analysis of tubularized incisedplate versus onlay island flap urethroplasty for penoscrotal hypospadias. J. Urol. 2007; 178:1451–7.45. Burgu B, Aydogdu O, Söylemez H et al. Both dorsal and ventral flaps can be used inpreviously circumcised hypospadic adults with comparable success rates. Int. Urol.Nephrol.2010; 42: 689–95.46. Marte A, Di Iorio G, De Pasquale M, Cotrufo AM, Di Meglio D. Functional evaluation oftubularized-incised plate repair of midshaft-proximal hypospadias using uroflowmetry. BJUInt. 2001 Apr;87(6):540-3. PubMed PMID: 11298053.47. Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G.Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolvespontaneously? J Pediatr Urol. 2011 Aug;7(4):441-5. Epub 2010 Jul 13. PubMed PMID:20630805.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Çalışma
Yazarlar

Yusuf Atakan Baltrak 0000-0001-8457-5108

Yayımlanma Tarihi 31 Aralık 2018
Kabul Tarihi 11 Eylül 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 8 Sayı: 4

Kaynak Göster

APA Baltrak, Y. A. (2018). Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi. Çağdaş Tıp Dergisi, 8(4), 291-294. https://doi.org/10.16899/gopctd.408192
AMA Baltrak YA. Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi. J Contemp Med. Aralık 2018;8(4):291-294. doi:10.16899/gopctd.408192
Chicago Baltrak, Yusuf Atakan. “Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi”. Çağdaş Tıp Dergisi 8, sy. 4 (Aralık 2018): 291-94. https://doi.org/10.16899/gopctd.408192.
EndNote Baltrak YA (01 Aralık 2018) Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi. Çağdaş Tıp Dergisi 8 4 291–294.
IEEE Y. A. Baltrak, “Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi”, J Contemp Med, c. 8, sy. 4, ss. 291–294, 2018, doi: 10.16899/gopctd.408192.
ISNAD Baltrak, Yusuf Atakan. “Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi”. Çağdaş Tıp Dergisi 8/4 (Aralık 2018), 291-294. https://doi.org/10.16899/gopctd.408192.
JAMA Baltrak YA. Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi. J Contemp Med. 2018;8:291–294.
MLA Baltrak, Yusuf Atakan. “Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi”. Çağdaş Tıp Dergisi, c. 8, sy. 4, 2018, ss. 291-4, doi:10.16899/gopctd.408192.
Vancouver Baltrak YA. Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi. J Contemp Med. 2018;8(4):291-4.