Hipospadias Cerrahisi Sonrası Üretral Darlığın Üroflowmetri İle Değerlendirilmesi

Özet

Bu çalışmanın amacı hipospadiaslı olgularda eşlik edebilecek alt üriner sistem obstruksiyonunu üroflowmetri ile değerlendirmek ve bu durumun klinik önemini vurgulamaktır. Kliniğimizde Ocak 2012 - Ocak 2013 tarihleri arasında takip ve tedavisi yapılan hipospadiaslı olguların idrarını tutabilen yaş grubunda olan ve ailesinin işleme yazılı onam verdiği 63 hastaya, ameliyat öncesi poliklinik değerlendirmede ve ameliyat sonrası dönemde eşlik eden alt üriner sistem obstruksiyonu değerlendirmek için üroflowmetri ile idrar akış ölçümleri yapıldı.Tüm hastaların işeme akım eğrisi paternleri tek tek incelendi. Literatüre uygun olarak azami akış hızı, ortalama akış hızı, azami akışa ulaşma süresi, idrar akış süresi, idrar boşaltma süresi, işeme sonrası rezidü idrar miktarı ve işeme eğrisi özelliği ameliyat öncesi ve ameliyat sonrası yapılan üroflowmetri test sonuçları ile karşılaştırıldı.Üroflowmetrinin orta ve uzun vadede hipospadias cerrahisi açısından üretral stenozun ve eşlik eden alt üriner sistem obstruksiyonun erken tanınmasında önemli, ucuz, kolay uygulanabilen non invaziv bir test oldugu düşünülmektedir.

Abstract

Aims:Uroflowmetry is a simple, noninvasive, easy to use and objectively interpretable urodynamic study. Uretral stenosis is the most common late complication after hypospadias surgery. The aim of this study was to evaluate the possible postoperative meatal stenosis in patients who were operated for hypospadias in our clinic with uroflowmetry.Material and Methods:The patients with hypospadias operated in our clinic between January 2015 and January 2017 were determined as our study group.Uroflowmetry and urine flow measurements were performed at least two months after the operation. After uroflowmetry measurement, the residual urine volume was measured by ultrasound device in pediatric surgery clinic. The estimated bladder volumes were calculated according to the age of the patients.Results:The median age of the patients was 7.5 (3-14). In the postoperative period, 9 (19.5%) of the patients had complaints of narrow urination and urination as a clinical complaint. No statistically significant difference was found between the two groups in terms of uroflowmetry results, maximum flow rate, time to reach maximum flow rate, total urine flow time, mean flow rate and residual urine volume (p> 0.005).Sixteen patients (25.4%) in the postoperative group were smaller than <-2SD according to the Siroky nomogram and were in the obstruction group. Conclusions: Uroflowmetry is an easy-to-use noninvasive test used to assess early obstruction and to diagnose a urethral stricture following hypospadias surgery. When compared with the literature, the maximum flow rate in uroflowmetry measurements is less than 10 ml / s, the average flow rate is low, the voiding curve is the plateau curve and the five-percentile according to the nomograms and the voiding curve smaller than -2 SD results are evaluated in terms of urethral obstruction and urethral dilatation planning is important.