Hypospadias repair with tubularized incised plate: Does the obstructive flow pattern resolve spontaneously?

Objective: The aim of this prospective study was to evaluate whether urinary flow improves with time after tubularized incised plate (TIP) repair. Patients and method: Between 1999 and 2003, primary TIP was performed in 126 boys. In patients old enough (48 boys, mean age at surgery 46 months, range 18-103), uroflowmetry was performed 1 year and 7 (median, range 3-10) years post surgery. Miskolc nomograms were used to compare results from the two follow ups (Q(max) in relation to voided volume and age). Results: Eleven boys had symptoms of obstruction resulting in intervention. For the other 37 boys, the mean Q(max) was 13.6 +/- 5.6 ml/s 1 year postoperatively (mean voided volume 107 +/- 43 ml) and 49% had flows below the 5th percentile. Seven years postoperatively the mean Q(max) was 19.0 +/- 8.1 ml/s (mean voided volume 235 112 ml) and 32% had flows below the 5th percentile. In the group with flows below the 5th percentile at 1 year, all improved and 28% improved to above the 25th percentile. Proximal hypospadias was more often associated with obstructive flow than distal (75%/75% compared to 43%/21% 1/7 years postoperatively). Conclusion: We found spontaneous improvement (P = 0.00022) 7 years after TIP repair, although many boys still had a Q(max) in the low normal or obstructive range. (C) 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.