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CC BY-NC-ND 4.0 · Eur J Pediatr Surg
DOI: 10.1055/a-2536-4549
Original Article

Diagnostic Accuracy of Uroflowmetry for Urethral Strictures in Pediatric Hypospadias: TIP versus Non-TIP Outcomes

Wei Ru   *
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Hongbo Liu   *
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Juan Zhou
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Qibo Hu
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Weifeng Yang
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Lizhe Hu
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Guangjie Chen
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
,
Xiang Yan
1   Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, People's Republic of China
› Institutsangaben Funding This work was financially supported by the Zhejiang Province Public Welfare Technology Application Research Project (LGD22H050002) from the Science and Technology Department of Zhejiang Province and the National Natural Science Foundation of China (No. 82273014).
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Abstract

Introduction

This study aimed to evaluate the diagnostic accuracy of uroflowmetry in detecting pediatric urethral strictures following tubularized incised plate (TIP) and non-TIP urethroplasty.

Materials and Methods

A retrospective cohort study was conducted on children who underwent primary hypospadias repairs from June 2016 to June 2023 at our institution. Patients were categorized into the TIP and the non-TIP groups. Urethral calibration and uroflowmetry were used to evaluate urethral patency following urethroplasty. Data on demographic characteristics, perioperative information, uroflowmetry results, urethral calibration outcomes, and postoperative complications were collected.

The relationship between calibration and uroflowmetry and the diagnostic accuracy of uroflowmetry for urethral strictures were analyzed.

Results

A total of 62 cases were included, with 38 in the TIP group and 24 in the non-TIP group. Ten patients were diagnosed with urethral strictures. The maximum urinary flow rate (Qmax) exhibited a higher area under the curve (AUC) than the average urinary flow rate (Qave) in both the TIP and non-TIP groups. The Qmax in the non-TIP group demonstrated a higher AUC than in the TIP group (non-TIP: AUC = 0.94, cutoff = 6.65 ml/s, sensitivity = 100%, specificity = 81.0%; TIP: AUC = 0.80, cutoff = 5.75 ml/s, sensitivity = 100%, specificity = 58.1%). A significant quadratic correlation was found between Qmax and urethral calibration (non-TIP: C 2 = 14.72 * Qmax, R 2 = 0.96; TIP: C 2 = 14.76 * Qmax, R 2 = 0.88). The Qmax nomogram interval ≤ −3 standard deviation was a significant predictor for non-TIP urethral strictures (kappa = 0.70).

Conclusion

Uroflowmetry, particularly Qmax, shows promise as a noninvasive screening tool for detecting urethral strictures after hypospadias repair. It has high diagnostic accuracy in non-TIP cases but limited utility in TIP cases.

Keywords

urethral stricture - calibration - uroflowmetry - hypospadias

Authors' Contributions

W.R.: Concept and design, methodology, data verification, statistical analysis, revision of the manuscript, and funding acquisition. H.L.: Concept and design, methodology, data collection, statistical analysis, and manuscript drafting. J.Z.: Concept and design, methodology, data collection, revision of the manuscript, and critical appraisal of the manuscript. Q.H.: Methodology, statistical analysis, revision, and critical appraisal of the manuscript. W.Y.: Reviewed proposal, statistical analysis, revision, and critical appraisal of the manuscript. L.H.: Reviewed proposal, revision, and critical appraisal of the manuscript. G.C.: Concept and design, methodology, project administration, revision, and critical appraisal of the manuscript. X.Y.: Concept and design, methodology, project administration, revision, final approval of the version to be published.


Ethical Approval

This study was approved by the Ethics Committee of Children's Hospital, Zhejiang University (2024-IRB-0262-P-01).


Data Availability

Data are available upon request.


Consent for Publication

This is a retrospective cohort study using an anonymized dataset.


* These authors contributed equally.


Supplementary Material



Publikationsverlauf

Eingereicht: 26. September 2024

Angenommen: 09. Februar 2025

Accepted Manuscript online:
11. Februar 2025

Artikel online veröffentlicht:
27. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ru W, Tang D, Wu D. et al. Identification of risk factors associated with numerous reoperations following primary hypospadias repair. J Pediatr Urol 2021; 17 (01) 61.e1-61.e5
    CrossrefPubMedSuche in Google Scholar
  • 2 Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral Stricture Disease Guideline Amendment (2023). J Urol 2023; 210 (01) 64-71
    CrossrefPubMedSuche in Google Scholar
  • 3 Cimador M, Vallasciani S, Manzoni G, Rigamonti W, De Grazia E, Castagnetti M. Failed hypospadias in paediatric patients. Nat Rev Urol 2013; 10 (11) 657-666
    CrossrefPubMedSuche in Google Scholar
  • 4 Mikolaj F, Karolina M, Oliwia K. et al. Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?. Int Urol Nephrol 2021; 53 (12) 2423-2435
    CrossrefPubMedSuche in Google Scholar
  • 5 Gelman J, Furr J. Urethral stricture disease: evaluation of the male urethra. J Endourol 2020; 34 (S1): S2-S6
    CrossrefPubMedSuche in Google Scholar
  • 6 Öztürk YD, Elmas AT, Tabel Y. Uroflowmetry parameters in healthy children between 5 and 15 years old. Low Urin Tract Symptoms 2023; 15 (06) 231-237
    CrossrefPubMedSuche in Google Scholar
  • 7 Wein AJ, Kavoussi LR, Partin AW, Peters CA. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. -3421
    Suche in Google Scholar
  • 8 Jesus LE, Schanaider A, Kirwan T. et al. Reduced flow after tubularized incised plate urethroplasty—increased fibrogenesis, elastin fiber loss or neither?. J Urol 2014; 191 (06) 1856-1862
    CrossrefPubMedSuche in Google Scholar
  • 9 Mekayten M, Meir E, Yutkin V. et al. Is there a correlation between meatal stenosis severity, lower urinary tract symptoms and uroflowmetry?. J Pediatr Urol 2022; 18 (03) 342.e1-342.e6
    CrossrefPubMedSuche in Google Scholar
  • 10 Hueber PA, Antczak C, Abdo A, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes of distal hypospadias repair: a single center retrospective comparative study of TIPs, Mathieu and MAGPI. J Pediatr Urol 2015; 11 (02) 68.e1-68.e7
    CrossrefPubMedSuche in Google Scholar
  • 11 Hueber PA, Salgado Diaz M, Chaussy Y, Franc-Guimond J, Barrieras D, Houle AM. Long-term functional outcomes after penoscrotal hypospadias repair: a retrospective comparative study of proximal TIP, Onlay, and Duckett. J Pediatr Urol 2016; 12 (04) 198.e1-198.e6
    CrossrefPubMedSuche in Google Scholar
  • 12 Wang CX, Zhang WP, Song HC. Complications of proximal hypospadias repair with transverse preputial island flap urethroplasty: a 15-year experience with long-term follow-up. Asian J Androl 2019; 21 (03) 300-303
    CrossrefPubMedSuche in Google Scholar
  • 13 Sekerci CA, Ozkan OC, Sahak MY. et al. Normal glanular and meatal measurements in boys and men. Urology 2023; 174: 159-164
    CrossrefPubMedSuche in Google Scholar
  • 14 Erickson BA, Ghareeb GM. Definition of successful treatment and optimal follow-up after urethral reconstruction for urethral stricture disease. Urol Clin North Am 2017; 44 (01) 1-9
    CrossrefPubMedSuche in Google Scholar
  • 15 Snodgrass WT, Bush NC. Management of urethral strictures after hypospadias repair. Urol Clin North Am 2017; 44 (01) 105-111
    CrossrefPubMedSuche in Google Scholar
  • 16 Campos-Juanatey F, Osman NI, Greenwell T. et al. European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): diagnosis, perioperative management, and follow-up in males. Eur Urol 2021; 80 (02) 201-212
    CrossrefPubMedSuche in Google Scholar
  • 17 Erickson BA, Breyer BN, McAninch JW. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. J Urol 2010; 184 (04) 1386-1390
    CrossrefPubMedSuche in Google Scholar
  • 18 Yanagi T, Kanematsu A, Shimatani K, Yamamoto S. Uroflowmetry is a viable surrogate for urethroscopy in evaluation of anatomical success following urethroplasty. Int J Urol 2023; 30 (04) 390-394
    CrossrefPubMedSuche in Google Scholar
  • 19 Kanematsu A. Editorial Comment to Validated uroflowmetry-based predictive model for the primary diagnosis of urethral stricture disease in men. Int J Urol 2018; 25 (09) 799
    CrossrefPubMedSuche in Google Scholar
  • 20 Lambert E, Denys MA, Poelaert F, Everaert K, Lumen N. Validated uroflowmetry-based predictive model for the primary diagnosis of urethral stricture disease in men. Int J Urol 2018; 25 (09) 792-798
    CrossrefPubMedSuche in Google Scholar
  • 21 Park JK, Kim JY, You JH. et al. Effect of preoperative urethral dilatation on preventing urethral stricture after holmium laser enucleation of the prostate: a randomized controlled study. Can Urol Assoc J 2019; 13 (11) E357-E360
    PubMedSuche in Google Scholar
  • 22 Boroda J, Gitlin J, Fang A. et al. A comparison of 467 uroflowmetry results in repaired hypospadias vs. normal male flows. J Pediatr Urol 2024; 20 (04) 690.e1-690.e7
    CrossrefPubMedSuche in Google Scholar
  • 23 Hadidi AT. Functional urethral obstruction following tubularised incised plate repair of hypospadias. J Pediatr Surg 2013; 48 (08) 1778-1783
    CrossrefPubMedSuche in Google Scholar
  • 24 Andersson M, Doroszkiewicz M, Arfwidsson C, Abrahamsson K, Holmdahl G. Hypospadias repair with tubularized incised plate: does the obstructive flow pattern resolve spontaneously?. J Pediatr Urol 2011; 7 (04) 441-445
    CrossrefPubMedSuche in Google Scholar