Urinary tract abnormalities in boys with recurrent urinary tract infections after hypospadias repair

Abstract

E.W. and P.P. contributed equally to this manuscript Objective• To examine the development of recurrent urinary tract infections (UTIs) in boys who have undergone hypospadias repair. Materials and Methods• We retrospectively reviewed the records of all boys who had recurrent UTIs after primary or redo tubularized incised plate (TIP) or transverse island flap (TVIF) repairs, between 1998 and 2009. • Data on age, operating 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, 43/2249 boys (1.91%) were diagnosed with recurrent UTIs after hypospadias repair. The boys' mean (range) age at repair was 14 (6-24) months and the median (range) follow-up was 6.5 (1.5-11) years.• Primary TIP and TVIF were performed in 47% (20/43) and 35% (15/43) of the boys, respectively. Redo surgeries were performed in 18% of the boys (8/43). The initial meatal location was proximal in all TVIF and redo repairs, and in one of the TIP repairs.• Postoperative voiding cysto-urethrography, ultrasonography and dimercapto-succinic acid (DMSA) scans were performed in 58% (25/43), 90% (39/43) and 19% (8/43) of the boys, respectively. Abnormalities were noted.• Of those boys who underwent a TVIF repair, urethral diverticula were seen in 47% (7/15) and urethral fistulae were also seen in 47% (7/15). Conversely, in those who had a TIP repair, an elevated PVR and vesico-ureteric reflux were more common; they were found in 40% (8/20) and 50% (10/20) of patients, respectively. Conclusions• The pathophysiology of recurrent UTI is multifactorial, but postoperative complications seem to vary with type of procedure.• Recurrent UTIs after hypospadias surgery should prompt a specific assessment for potentially functionally relevant and correctable anatomical abnormalities.

Prospective assessment of cosmesis before and after genital surgery

“…Less is known about frequency of UTIs after masculinizing genitoplasty. Among those with hypospadias repair, UTIs are a relatively uncommon complication, although this may vary by type of procedure performed [20]. …”

Urinary Tract Infection in Boys with Hypospadias

“…The issue of whether boys with hypospadias have a higher incidence of urinary tract infections has been debated. Wehbi et al 7 Stated that the incidence of recurrent UTIs in hypospadias patients is higher over time (1.9%) than that of boys without this malformation (0.1-0.2%), with a median follow-up time of 6.5years. 7 This is in accordance with our postoperative results.…”

“…Wehbi et al 7 Stated that the incidence of recurrent UTIs in hypospadias patients is higher over time (1.9%) than that of boys without this malformation (0.1-0.2%), with a median follow-up time of 6.5years. 7 This is in accordance with our postoperative results. Our study focused both on UTIs occurring near the surgery date, where the use of prophylactic antibiotics can have an impact, as well as over a longer duration.…”

“…4 Previous studies regarding the use of prophylactic antibiotics after hypospadias repair show a difference of opinion. [4][5][6][7][8] Due to increasing prevalence of antibiotic resistance it is important to investigate whether the incidence of UTIs is higher in hypospadias patients and what actions should be taken regarding the antibiotic use associated with the operation. 9 The aim of this study was to evaluate the frequency of urinary tract infections in boys with hypospadias pre-peri-and post-operatively in order to determine whether antibiotic prophylaxis is warranted for those undergoing a reconstructive surgery for their hypospadias.…”

The World's Youngest Cadaveric Kidney Transplant: Medical, Surgical and Ethical Issues

“…In addition, with his Denys-Drash syndrome, he would almost certainly go on to develop malignant tumours in his own native kidneys, and his hypospadias would increase the likelihood of postoperative urinary tract infections. 15,16 Yet if the transplant was to succeed, he could have his native kidneys removed at a later date, and his hypospadias could be surgically corrected.…”