THE ASSOCIATION BETWEEN COLLAGEN, INFLAMMATION, AND FIBROSIS WITH MAXIMUM URINARY FLOW RATE IN HYPOSPADIAS PATIENTS AFTER URETHROPLASTY
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Abstract
Introduction: Hypospadias repair may cause long-term urinary dysfunction. Collagen, inflammation, and fibrosis may influence urethral healing and urinary flow, but their association with postoperative Qmax remains unclear. Objective: This study aims to investigate the relationship between collagen, inflammation, and fibrosis with maximum urinary flow rate in patients with hypospadias after urethroplasty. Material & Methods: This retrospective cohort study included 72 hypospadias patients who underwent surgery at Ngoerah General Hospital, Denpasar, from 2003 to 2013. Urethral tissue samples were histopathologically assessed for collagen, inflammation, and fibrosis. Urinary flow was evaluated 10 years postoperatively using uroflowmetry, with Qmax categorized based on the optimal ROC-derived cutoff. Associations were analyzed using chi-square and logistic regression. Results: The results showed a significant association between collagen and maximum urinary flow rate (RR=0.573; 95% CI=0.350–0.936; p=0.019), where low collagen levels were protective against weak urinary stream. Moderate-to-severe fibrosis increased the risk of weak urinary stream by 1.6 times (RR=1.659; 95% CI=1.071–2.568; p=0.026). However, no significant association was found between inflammation and maximum urinary flow rate (p=0.964). Logistic regression analysis indicated that patient age was significantly associated with maximum urinary flow rate (OR=1.32; p=0.002). Conclusion: There is an association between collagen levels and maximum urinary flow rate in patients after hypospadias surgery. However, no significant association was found between inflammation and fibrosis with urinary flow. Patient age was the dominant factor influencing urinary flow post-surgery. Keywords: Collagen, inflammation, fibrosis, maximum urinary flow rate, urethroplasty.
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Collagen, inflammation, fibrosis, maximum urinary flow rate, urethroplasty.
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Krisna DM, Maulana A. Hipospadia : How is The Characteristics in Indonesia. 2017;(April): 325–33.
Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Palinrungi MAA, Et Al. Common Practice of Hypospadias Management by Pediatric Urologists in Indonesia : A Multi-Center Descriptive Study From Referral Hospitals. 2019;7(14):2242–5.
Duarsa GWK, Pratiwi DA, Tirtayasa PW, Yudiana W, Santosa KB. Functional and Cosmetic Urethroplasty Outcome , Emotional Stress After Genital Examination , Post Traumatic Stress Disorder , and Ages at The Time of Urethroplasty as Potential Risk Factor Causing Psychosocial Disorder of Hypospadia Children. 2019;7(9):1452–5.
Mohammed M, Bright F, Mteta A, Mbwambo J, Nicholaus B, Yongolo S, Et Al. Long-Term Complications of Hypospadias Repair: A Ten-Year Experience From Northern Zone of. 2020;463–9.
Duarsa GWK, Pratama PKD, Sabudi IMNGG, Oktavius D. Graft Procedure on Urethroplasty , In Comparison With Flap Procedure : A Literature Review. 2019;8(3):592–5.
Duarsa GWK, Lawanto SD, Oka AAG, Santosa KB, Yudiana IW, Tirtayasa PMW, Et Al. Flap Method is Better Than The Tubularized Incised Plate Method for The Surgical Treatment of Distal Hypospadias. 2020;8(September 2017):569–72.
Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Utomo T, Et Al. Risk Factors For Urethrocutaneous Fistula Following Hypospadias Repair Surgery in Indonesia. J Pediatr Urol [Internet]. 2020;16(3):317.E1-317.E6. Available From: Https://Doi.Org/10.1016/J.Jpurol.2020.04.011
Fernández VR, López C, Ortiz EM, Carrera NS. Case Report Accurate Diagnosis Of Severe Hypospadias Using 2D and 3D Ultrasounds. 2016.
Yuri P, Lestari RP, Fardilla FP, Ananda W, Setyaningsih W. The Impact of COL1A1 and COL6A1 Expression on Hypospadias and Penile Curvature Severity. 2020;1–5.
Saksono YWS, Sutyadhi NT, Duarsa GWK. Tipe Hipospadia Proksimal Merupakan Faktor Risiko Pancaran Urin yang Lemah pada Pasien Hipospadia Pascauretroplasti Teknik Tubularized Incised Plate. 2017;48(3):220–3.
Dale J, Woodward B, Elagami H. Age ‑ Dependent Early Complications of Hypospadias Repair : A Single Institutional Experience. Pediatr Surg Int [Internet]. 2023;1–4. Available from: https://doi.org/10.1007/s00383-023-05388-z
Ziada A, Hamza A, Abdel-rassoul M, Habib E, Mohamed A, Daw M. Outcomes of Hypospadias Repair in Older Children : A Prospective Study. JURO [Internet]. 2011;185(6):2483–6. Available from: http://dx.doi.org/10.1016/j.juro.2011.01.032
Garnier S, Maillet O, Cereda B, Ollivier M, Jeandel C, Broussous S, et al. Late Surgical Correction of Hypospadias Increases The Risk of Complications : A Series of 501 Consecutive Patients. 2017;942–7.
Silva EA, Marins RL, Rondon A, Damiao R. Age-Related Structural Changes of The Urethral Plate in Hypospadias. 2013.
Sharma SP, Chowdhary S, Kumar R, Yadav MK, Sharma SP, Panigrahi P. Urinary Flow Rates in Anterior Hypospadias : Before and After Repair and its Clinical Implication. 2023.
Subnafeu R, Duarsa GWK, Mahadewa TGB. Eksisi dan Anastomosis Primer Memberikan Luaran Nilai Qmax , Penggunaan Clean Intermitten Catheterization , dan Penile Perception Scores yang Lebih Baik Dibandingkan Terapi Minimal Invasif pada Penanganan Striktur Uretra Posterior Parsial Di Bali. 2021;(June 2019).
Acimi S. Anatomical Explanations of the Pathogenesis of Proximal Hypospadias. 2019;97–9.
Karakan T, Ozcan S, Bagcioglu M, Aydın A, Doluoglu OG, Yucel MO, et al. The Effect of Intraurethral Dexpanthenol in Hypospadias Repair : Experimental Rabbit Study. J Pediatr Urol [Internet]. 2019;15(4):375.e1-375.e5. Available from: https://doi.org/10.1016/j.jpurol.2019.04.003
Zhang Q, Pang S, Zhang Y, Jiang K, Guo X. Association between Inflammation and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia. Urol J. 2020;17(5):505–11.