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CC BY-NC-ND 4.0 · Eur J Pediatr Surg 2025; 35(04): 309-315
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
› Author Affiliations
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



Publication History

Received: 26 September 2024

Accepted: 09 February 2025

Accepted Manuscript online:
11 February 2025

Article published online:
27 March 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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