Longitudinal Evolution of Uroflowmetry Patterns from Childhood to Puberty After Hypospadias Repair: A 12-Year Cohort Study

Objective To evaluate long-term changes in uroflowmetry patterns from childhood to puberty after hypospadias repair and identify boys with abnormal urinary flow who may require surgery. Materials and Methods This retrospective cohort included patients who underwent hypospadias repair with creation of a neourethra at a tertiary center between 2000 and 2006, with minimum follow-up of 12 years. Patients were grouped by hypospadias severity and assessed with uroflowmetry at prepubertal age and during puberty. Flow patterns were classified according to International Children’s Continence Society criteria, and flow index was calculated to adjust maximum flow rate for voided volume. Results Forty-seven patients (20 distal, 27 proximal) were included. Prepubertal plateau-shaped flows occurred in 23 patients (48.9%). Among these, spontaneous improvement occurred in 15, surgery for symptomatic obstruction was required in 6 (26.1%), and plateau-shaped flow persisted without symptoms in 2. In patients with prepubertal plateau-shaped flow not requiring surgery, median maximum flow rate increased from 11.2 mL/s prepuberty to 21.4 mL/s during puberty ( P < .001), with a corresponding rise in flow index. No significant differences in long-term uroflowmetry outcomes were observed between distal and proximal hypospadias. Conclusion Most plateau-shaped flow patterns after hypospadias repair improve spontaneously during puberty, supporting conservative management in asymptomatic patients. Surgery should be reserved for boys with persistent abnormal flow and urinary symptoms.