Pediatrics(구연) Oral session 7 / Pediatrics (Ⅰ) (O-062) Crystal B (3F) 11월28일(수) 14:00-15:00 Urethral diverticulectomy after hypospadias repair : A critical outcome analysis 연세대학교 의과대학 비뇨의학과교실 이초녕, 김상운, 이용승, 한상원 Purpose Although urethral diverticulum is one of the complications of hypospadias surgery that occurs with relatively high frequency, there are only a few reports on its treatment. We evaluate our outcomes of urethral diverticulectomy and analyze the results to determine risk factors associated with complications after diverticulectomy. Patients Between January 2005 and Jan 2018, 175 patients underwent urethral diverticulectomy after primary hypospadias repair in our institution. Urethral diverticulectomy had been performed using one of three different techniques including simple diverticulectomy, local urethral flap and plication technique. Among these, 87 patients underwent simple urethral diverticulectomy. After re-establishing distal urethral patency with sound dilator, diverticulectomy was carried out with skin incision avoiding midline and degloving penile skin. Redundant diverticular tissue was resected and sutured, followed by overlapping periurethral flap and covering skin flap. Results The mean age at surgery was 1.9 years and follow up duration was 55.9 months. The primary surgery for hypospadias repair was tubulized incised plate in 13, tubulized preputial island flap in 72, buccal mucosa graft in 2 patients. Sixteen children with combined stricture underwent simultaneous procedures for stricture (14 end-to-end anastomosis, 1 relaxing incision on urethra, 1 onlay buccal mucosa graft). In overall, 56 patients (64.4%) demonstrated no complication after diverticulectomy. Twenty-one (24.1%) had recurred diverticulum and 9 (9.2%) had stricture during follow-up. Secondary procedures were required in 31 patients, and redo-diverticulectomy was most frequently performed (23 patients). According to the type of primary surgery for hypospadias repair, children with tubulized incised plate urethroplasty had no post-diverticulectomy complication while 38 children (52.8%) with tubulized preputial island flap required secondary procedures for complications (p=0.002). Conclusion The overall success rate of urethral diverticulectomy was 64.4% in children after hypospadias repair, which was lower than previous reports. Patients who underwent tubulized preputial island flap demonstrated worse results than those with tubulized incised plate. A careful investigation for occult distal obstruction and follow-up maybe required after urethral diverticulectomy. keywords : Hypospadias, diverticulum