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Vesicoureteral reflux (VUR) is unexpectedly common in boys with hypospadias, even without symptoms or urinary tract infections. Pre- and postoperative micturition cystourethrography (MCU) is recommended for evaluating VUR in these patients.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Diagnostic Imaging
Background:
- Hypospadias is a common congenital anomaly requiring surgical correction.
- Associated conditions include meatal stenosis and müllerian duct remnants.
- Vesicoureteral reflux (VUR) is an infrequently reported association with hypospadias.
Purpose of the Study:
- To investigate the prevalence of VUR in pediatric hypospadias patients.
- To assess the utility of micturition cystourethrography (MCU) in pre- and postoperative evaluation.
- To identify potential risk factors or associations for VUR in this cohort.
Main Methods:
- Prospective evaluation of 305 hypospadias patients using MCU.
- MCU performed preoperatively and three months postoperatively.
- Correlation of VUR findings with clinical presentation, surgical status, and complications like meatal stenosis.
Main Results:
- VUR was detected in 58 of 305 (19%) hypospadias patients via MCU.
- Most VUR cases were Grade II.
- VUR was diagnosed preoperatively in 37 patients and postoperatively in 21 patients; 10 developed VUR post-surgery, often linked to distal urethral strictures.
Conclusions:
- Vesicoureteral reflux is a significant, often asymptomatic, finding in pediatric hypospadias.
- Routine preoperative and postoperative MCU is crucial for detecting VUR in hypospadias patients.
- Postoperative VUR may be associated with urethral strictures and can sometimes resolve with intervention.
Abstract:
Hypospadias in a congenital anomaly which in most cases has to be corrected surgically. We include micturition cystourethrography (MCU) in the preoperative workup of all these children as well as three months postoperatively. Meatal stenosis and müllerian duct remnants are known to occur in this condition, but vesicoureteral reflux (VUR) was an unexpected finding in many boys who were asymptomatic and had no evidence of urinary tract infection. Fifty-eight of 305 hypospadiacs, examined by MCU, proved to have reflux, most of them grade II. In 37, VUR was found before surgery and in the remaining 21 after surgical correction, many of them with meatal stenosis. In 10 patients reflux appeared in the postoperative period where there had been none in the preoperative study; 8 of the 10 had a postoperative stricture of the distal urethra, and VUR subsided in 4 after adequate dilatation. We conclude that vesicoureteral reflux is not uncommonly found in patients with hypospadias, even in those who are completely asymptomatic. We believe this is an additional incentive to include an MCU in the pre- and postoperative evaluation of patients with this anomaly.