L.M.O. de Kort

Functional, cosmetic and psychosexual results in adult men who underwent hypospadias correction in childhood

OBJECTIVE Long-term results of hypospadias repair are scarce. Previous reviews mostly described mid-term results making extrapolation to long-term results difficult. This systematic review on long-term results in postpubertal men after hypospadias repair in childhood, aims to inform urologists and parents of a newborn boy with hypospadias about future expectations. METHODS AND MATERIALS The Pubmed/Medline and Embase databases were searched until February 2010. Inclusion criteria stated that patients with hypospadias were operated before the age of 6 years and were older than 14 years at follow up. Results were pooled and analyzed using SPSS 16.0. Data on proximal hypospadias patients and controls are described separately. RESULTS Twenty eligible studies investigating micturition, cosmesis and psychosexual functioning were found. Hypospadias patients report more urinary symptoms and have a lower Qmax than controls. Patients are less satisfied with penile appearance compared to controls. Objectively assessed cosmetic results are good. Sexually, patients are as active as controls, but are less satisfied. Patients less often have an intimate relationships compared to controls. CONCLUSION Study outcomes were heterogeneous due to operation techniques and a lack of validated questionnaires and control groups. Long-term results of hypospadias patients should be measured in a prospective design using validated measurement tools.

The management of adolescents with neurogenic urinary tract and bowel dysfunction

Most children with neurogenic bladder dysfunction arrive into adolescence with reasonably managed lower urinary tract function only to experience bladder and kidney function deterioration after puberty. The aim of this article is to identify issues that contribute to adverse changes in bladder and renal function during adolescence and to highlight strategies to preserve urinary tract integrity, social continence, patient autonomy, and independence.

Assessment of Non-Neurogenic Incontinence and Lower Urinary Tract Symptoms in Adolescents and Young Adults

The aim of this article is to provide insight to clinicians who principally treat adults, about non‐neurogenic lower urinary tract symptoms (LUTS) either pre‐dating or presenting in adolescence. Assessment fundamentals, diagnostic classification, and rationale behind the process of care are discussed.

990 International Continence Society definition of detrusor underactivity; analysis of clinical parameters and comparison with contractility grading methods

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) experienced by elderly men may be due to bladder outlet obstruction, detrusor underactivity (DU) or a combination of both. The International Continence Society (ICS) defines DU as ‘a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span’. This definition is quantifiable by the following non-invasive urodynamic parameters: voiding time (VT), post void residual (PVR) and voiding efficiency (void%). The best method to determine DU is by pressure flow study. Three parameters to grade detrusor voiding contraction are Schafer pressure/flow nomogram (LinPURR), bladder contractility index (BCI) and maximum Watt Factor (Wmax). The goal of this study was to compare three methods of grading detrusor contraction and to correlate results with noninvasive measurements of DU VT, PVR and void%. METHODS: We evaluated 1420 urodynamic pressure flow studies of men > 50 years of age with LUTS. Patients with abnormal urinalysis, neurological disorders, pelvic or urological surgery, or with evidence of urethral stricture were excluded. We determined VT, PVR and void% of all measurements and graded contractility with LinPURR, BCI and Wmax. Correlation of different grading methods regarding contractility groups was done using either Spearman or Pearson correlation test. A threshold of 80% for void% was chosen as a normal limit. We tested diagnostic values of VT, PVR and void% and combinations of this parameters related to contractility groups by calculating specificity and sensitivity. RESULTS: LinPURR and BCI as well as LinPURR and Wmax contractility groups showed a highly significant correlation (0.975, p<0.000), (0.620, p<0.001) respectively. Sensitivity and specificity of VT, PVR and void% have been calculated for LinPURR contractility. Combining VT and void% showed a sensitivity of 71.0% and a specificity of 62.5%. Combining VT and PVR showed a sensitivity of 38.9% and a specificity of 38.2%. Combining VT and void% diagnosed 35.7% and combining VT and PVR diagnosed 42.8% of the DU as normal contractility in LinPURR contractility grading. CONCLUSIONS: Results of LinPURR, BCI and Wmax contractility grading were highly correlated. Therefore, because of simplicity, we suggest to use LinPURR classification in daily practice. The combination of void% and VT nor PVR and VT is specific in predicting detrusor underactivity.

715 LONG-TERM FOLLOW UP INTO ADULTHOOD OF BOYS OPERATED FOR HYPOSPADIAS: A STUDY INTO FUNCTIONAL AND COSMETIC RESULTS

Study design, materials and methods Between January 1987 and January 1992, 116 patients, now adults, were operated for hypospadias in our institution. Ninety-one of them could be traced and were included in this study. Patients were asked to complete questionnaires on the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), the Nederlandse Relatie Vragenlijst (NRV, Dutch Relationship Survey) as well as additional questions. Cosmetic results were assessed using the Hypospadias Objective Penile Evaluation (HOPE) score and uroflowmetry with post void residual measurement by ultrasound was performed. As a control group, 151 male medical students filled out the questionnaire (IPPS and IIEF) and underwent uroflowmetry. Acquired data was analyzed using SPSS 12.0. Data analysis was done by Students’ T-test, Chi-square test, ANOVA, Pearson’s and Spearman’s rank correlation with a p-value <0.05 considered significant.