Long term results
Emmett just turned 2. And while for most, hitting the 2-year mark alone is a cause for celebration, for me it’s a graceful reminder that we’re that much further along and still doing fantastic. It’s funny how life goes, isn’t it? We can get caught up in so many things. Bills, relationships, travel, work, drama and strife, but when something happens with one of our children, like hypospadias surgeries, healing and recovering, maybe a suggested diagnosis in utero, complications or whatever it may be, their wellness can become the most important thing ever. Most mamas who read my blog, or at least those who contact me, have a kiddo that’s been diagnosed with proximal hypospadias and most often with chordee. So for most of you, hypospadias is a big deal. You research and prepare as much as possible, and try and provide the best outcome for your little one. So as Emmett’s birthday came and went, we celebrated the grace of this two-year mark and how happy and well our little guy is with cake that was sweet, and wine that was good.
So, now that Emmett’s nine months out from his stage two hypospadias repair, how is he peeing? Perfectly. I still can’t help delaying a few minutes between diaper changes to catch a peek at his stream (my husband still thinks I’m crazy), and I cheer madly with big high fives when he releases an unobstructed, beautiful stream from his handsome little package. And you know, I might just do this until he no longer lets me. Sometimes I’m asked if I’ve thought about how and when we’ll talk to Emmett about hypopsadias. And I think this cheering and ongoing celebration speaks to just that. I want him to love his penis, feel so open about it and celebrate his journey through this. I feel like when he was little, and even in utero, we fought a battle together that he was strong for, and should be proud of. Perhaps this way he can be comfortable if there’s ever anything ‘off’ for him in the future.
After Emmett’s stage two repair when we had some difficulty voiding, I began trying to better understand the long term results of hypospadias surgery and urinary function from a flow, or stream, perspective. I find this is also a big concern for us moms: What will the future hold for my little guy? Talking to surgeons, I found there isn’t extensive long term data. The range of followup lies between 6 weeks and 9 years, however the majority of followups fail to address the issue of ‘lost to follow up’ or ‘excluded from study’; likely due to privacy concerns. In fact, while some surgeons like to follow hypospadias repair through adolescence and on as possible, other leading hypospadias surgeons feel this is more for them than for the child and can prolong the issue for the family. I’m probably in the second camp, however, as moms this leaves us to wonder about the long term results or ultimate functional outcome for our boys as they get older.
Uroflowmetry can be used to evaluate long term functional outcomes and results of hypospadias surgery by assessing flow shape and the rate of micturition – maybe why I’m obsessed with ‘the stream’. Studies have assessed urethral function using uroflowmetry in young adults following hypospadias repair in infancy and compared those results with age matched controls. A 2012 American Urological Association study found at long term followup after hypospadias surgery in infancy and young adulthood, urinary flow rates were significantly lower compared to age matched controls, but still fell within the normal range. Of interest to moms, this study found no correlation with original meatal location, number of operations, presence of postoperative complications, and current anatomy and lower urinary tract symptoms, such as post void dribbling, hesitancy or incontinence, however it did find the more severe the preoperative chordee the higher the likelihood of poorer urinary flow rates at long term followup. Chordee is graded in degrees, so 30 degrees, 45 degrees or 90 degrees, and also as mild, moderate or severe.
The takehome: Hypospadias is a challenging urogenital reconstructive surgery with a myriad of techniques that have been used in its repair. With today’s surgical advancement and skilled surgeons, it is possible to create a functionally and cosmetically normal penis, however for providers and for us as parents, complication rate, cosmetic appearance, ultimate functional outcome, including both the ability to micturate well and have normal sexual functionality, as well as psychological factors are valuable as they apply to future hypospadias surgery, and should probably be continually assessed and evaluated now and into the future.