Zhou Qian,Zhang Weiping,Song Hongcheng,et al.Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty[J].Journal of Clinical Pediatric Surgery,,22():1139-1145.[doi:10.3760/cma.j.cn101785-202202009-009]
Analysis of risk factors for urethral fistula of hypospadias repair with tubularized incised plate urethroplasty
- Keywords:
- Hypospadias; Surgical Procedures; Operative; Treatment Outcome; Postoperative Complications; Risk Factors; Child
- Abstract:
- Objective To evaluate the efficacy and risk factors of urethral fistula with tubularized incised plate urethroplasty (TIPU).Methods From December 2018 to January 2020,126 children with hypospadias undergoing primary TIPU were consecutively recruited.General demographics and intraoperative data were recorded.Electronic surgical records were reviewed and telephone follow-ups conducted,including types and occurrence time of complications.Univariate analysis was conducted for potential risk factors of urethral fistula.Variables with statistical significance were selected for Logistic multivariate analysis.Results During a mean follow-up period of 20.2 mouths,2 cases were lost.Median age was 24 months.The position of urethral opening accounted for 58.1% of anterior type,29.8% of intermediate type and 12.1% of posterior type respectively.The preoperative proportion of mild/moderate/severe penile curvature was 29.8%,54.8% and 15.3% respectively.Penile curvature was corrected by penile degloving and dorsal plication.And 59.5% of children with mild penile curvature and 33.8% of moderate penile curvature were corrected only by degloving while all cases of severe penile curvature managed by dorsal plication.The overall complication rate of TIP surgery was 26.6%,including urethral stricture (n=10,8.1%),urethral fistula (n=23,18.5%),penile fistula (n=17,13.7%) and penile head fissure (n=6,4.8%).In univariate analysis,age,surgeon experiences or new urethra coverage had no correlation with postoperative urethral fistula.Urethral fistula was significantly higher in smaller glans,posterior hypospadias,severer penile curvature after degloving and chordee requiring dorsal plication.In multivariate analysis,glans width<14 mm were independent risk factors for postoperative urethral fistula with TIP.Conclusions TIPU has a satisfactory efficacy for anterior/mediate hypospadias.The incidence of urethral fistula for posterior hypospadias is high with a poor efficacy.Children with smaller glans or severer penile curvature after degloving have a higher incidence of urethral fistula and glans width<14 mm are independent risk factors for postoperative urethral fistula after TIPU.As compared to covering foreskin vascular pedicle,TIP surgery using Buck’s fascia coverage has a lower incidence of urethral fistula.However,the incidence of urethral stricture is higher.The indications of TIP surgery should be strictly controlled for lowering the incidence of postoperative complications.
References:
[1] 中华医学会小儿外科学分会泌尿学组.尿道下裂专家共识[J].中华小儿外科杂志,2018,39(12):883-888.DOI:10.3760/cma.j.issn.0253-3006.2018.12.002. Group of Urology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Managing Hypospadias[J].Chin J Pediatr Surg,2018,39(12):883-888.DOI:10.3760/cma.j.issn.0253-3006.2018.12.002.
[2] Snodgrass W,Bush NC.Re-operative urethroplasty after failed hypospadias repair:how prior surgery impacts risk for additional complications[J].J Pediatr Urol,2017,13(3):289.e1-289.e6.DOI:10.1016/j.jpurol.2016.11.012.
[3] Wilkinson DJ,Farrelly P,Kenny SE.Outcomes in distal hypospadias:a systematic review of the Mathieu and tubularized incised plate repairs[J].J Pediatr Urol,2012,8(3):307-312 DOI:10.1016/j.jpurol.2010.11.008.
[4] Stanasel I,Le HK,Bilgutay A,et al.Complications following staged hypospadias repair using transposed preputial skin flaps[J].J Urol,2015,194(2):512-516.DOI:10.1016/j.juro.2015.02.044.
[5] Snodgrass W,Bush N.TIP hypospadias repair:a pediatric urology indicator operation[J].J Pediatr Urol,2016,12(1):11-18.DOI:10.1016/j.jpurol.2015.08.016.
[6] Zu’bi F,Chua M,El Ghazzaoui A,et al.Competency in tubularized incised plate repair for distal hypospadias:cumulative sum learning curve analysis of a single surgeon experience[J].J Urol,2020,204(6):1326-1332.DOI:10.1097/JU.0000000000001231.
[7] Bush NC,Snodgrass W.Pre-incision urethral plate width does not impact short-term tubularized incised plate urethroplasty outcomes[J].J Pediatr Urol,2017,13(6):625.e1-625.e6.DOI:10.1016/j.jpurol.2017.05.020.
[8] 刘愉,覃道锐,王学军,等.初治尿道下裂TIP手术后并发症的相关因素分析:309例单中心研究[J].临床小儿外科杂志,2020,19(12):1094-1099.DOI:10.3969/j.issn.1671-6353.2020.12.007. Liu Y,Qin DR,Wang XJ,et al.Analysis of related factors of complications after tubularized incised plate for initial hypospadias:a single-center report of 309 cases[J].J Clin Ped Sur,2020,19(12):1094-1099.DOI:10.3969/j.issn.1671-6353.2020.12.007.
[9] 沈一丁,唐达星,吴德华,等.规范手术操作程序的尿道板纵切卷管尿道成形术治疗原发性尿道下裂[J].中华小儿外科杂志,2020,41(2):171-175.DOI:10.3760/cma.j.issn.0253-3006.2020.02.015. Shen YD,Tang DX,Wu DH,et al.Clinical application of standardized tubularized incised plate urethroplasty for pediatric hypospadias[J].Chin J Pediatr Surg,2020,41(2):171-175.DOI:10.3760/cma.j.issn.0253-3006.2020.02.015.
[10] Pfistermuller KLM,McArdle AJ,Cuckow PM.Meta-analysis of complication rates of the tubularized incised plate (TIP) repair[J].J Pediatr Urol,2015,11(2):54-59.DOI:10.1016/j.jpurol.2014.12.006.
[11] Snodgrass W,Bush N.Recurrent ventral curvature after proximal TIP hypospadias repair[J].J Pediatr Urol,2021,17(2):222.e1-222.e5.DOI:10.1016/j.jpurol.2020.11.030.
[12] 潮敏,张殷,蒋加斌,等.BUCK筋膜联合阴茎头两翼整体覆盖恢复尿道下裂阴茎解剖结构在尿道板纵切尿道卷管成形术中的应用效果[J].临床小儿外科杂志,2020,19(12):1088-1093,1112.DOI:10.3969/j.issn.1671-6353.2020.12.006. Chao M,Zhang Y,Jiang JB,et al.Application experiences of integral covering technique of Buck’s fascia plus glans wings during tubularized incised plate urethroplasty for restoring normal penile anatomy of hypospadias[J].J Clin Ped Sur,2020,19(12):1088-1093,1112.DOI:10.3969/j.issn.1671-6353.2020.12.006.
[13] Bush NC,DaJusta D,Snodgrass WT.Glans penis width in patients with hypospadias compared to healthy controls[J].J Pediatr Urol,2013,9(6 Pt B):1188-1191.DOI:10.1016/j.jpurol.2013.05.004.
[14] Bush NC,Villanueva C,Snodgrass W.Glans size is an independent risk factor for urethroplasty complications after hypospadias repair[J].J Pediatr Urol,2015,11(6):355.e1-355.e5.DOI:10.1016/j.jpurol.2015.05.029.
[15] 唐耘熳.尿道下裂术后尿道狭窄、阴茎头裂开及尿道憩室的认识及处理[J].临床小儿外科杂志,2017,16(3):212-214.DOI:10.3969/j.issn.1671-6353.2017.03.002. Tang YM.Understanding and measures of urethral stricture,glan rupture and urethral diverticula after hypospadias repair[J].J Clin Ped Sur,2017,16(3):212-214.DOI:10.3969/j.issn.1671-6353.2017.03.002.
[16] 刘伟,武翔宇,王晓庆,等.尿道板纵切卷管尿道成形术后阴茎头裂开的相关危险因素分析[J].中华小儿外科杂志,2019,40(11):963-966.DOI:10.3760/cma.j.issn.0253-3006.2019.11.002. Liu W,Wu XY,Wang XQ,et al.Risk factors of glan dehiscence after repairing hypospadias with tubularized incised plate urethroplasty[J].Chin J Pediatr Surg,2019,40(11):963-966.DOI:10.3760/cma.j.issn.0253-3006.2019.11.002.
[17] Kaya C,Radmayr C.The role of pre-operative androgen stimulation in hypospadias surgery[J].Transl Androl Urol,2014,3(4):340-346.DOI:10.3978/j.issn.2223-4683.2014.12.01.
[18] Merriman LS,Arlen AM,Broecker BH,et al.The GMS hypospadias score:assessment of inter-observer reliability and correlation with post-operative complications[J].J Pediatr Urol,2013,9(6 Pt A):707-712.DOI:10.1016/j.jpurol.2013.04.006.
[19] Holland AJA,Smith GHH.Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty[J].J Urol,2000,164(2):489-491.DOI:10.1016/S0022-5347(05)67408-3.
[20] Sarhan O,Saad M,Helmy T,et al.Effect of suturing technique and urethral plate characteristics on complication rate following hypospadias repair:a prospective randomized study[J].J Urol,2009,182(2):682-686.DOI:10.1016/j.juro.2009.04.034.
[21] Weber DM,Sch?nbucher VB,Landolt MA,et al.The pediatric penile perception score:an instrument for patient self-assessment and surgeon evaluation after hypospadias repair[J].J Urol,2008,180(3):1080-1084.DOI:10.1016/j.juro.2008.05.060.
[22] Mosharafa AA,Agbo-Panzo D,Priso R,et al.Repair of hypospadias:the effect of urethral plate configuration on the outcome of Duplay-Snodgrass repair[J].Prog Urol,2009,19(7):507-510.DOI:10.1016/j.purol.2009.02.013.
[23] Ru W,Shen J,Tang DX,et al.Width proportion of the urethral plate to the glans can serve as an appraisal index of the urethral plate in hypospadias repair[J].Int J Urol,2018,25(7):649-653.DOI:10.1111/iju.13585.
[24] Section on Urology.Timing of elective surgery on the genitalia of male children with particular reference to the risks,benefits,and psychological effects of surgery and anesthesia[J].Pediatrics,1996,97(4):590-594.DOI:10.1542/peds.97.4.590.
[25] Lu WL,Tao YH,Wisniewski AB,et al.Different outcomes of hypospadias surgery between North America,Europe and China:is patient age a factor?[J].Nephrourol Mon,2012,4(4):609-612.DOI:10.5812/numonthly.1853.
[26] Ziada A,Hamza A,Abdel-Rassoul M,et al.Outcomes of hypospadias repair in older children:a prospective study[J].J Urol,2011,185(6 Suppl):2483-2485.DOI:10.1016/j.juro.2011.01.032.
[27] Eassa W,Jednak R,Capolicchio JP,et al.Risk factors for re-operation following tubularized incised plate urethroplasty:a comprehensive analysis[J].Urology,2011,77(3):716-720.DOI:10.1016/j.urology.2010.07.467.
[28] Yildiz T,Tahtali IN,Ates DC,et al.Age of patient is a risk factor for urethrocutaneous fistula in hypospadias surgery[J].J Pediatr Urol,2013,9(6 Pt A):900-903.DOI:10.1016/j.jpurol.2012.12.007.
[29] Bush NC,Holzer M,Zhang S,et al.Age does not impact risk for urethroplasty complications after tubularized incised plate repair of hypospadias in prepubertal boys[J].J Pediatr Urol,2013,9(3):252-256.DOI:10.1016/j.jpurol.2012.03.014.
[30] Snodgrass W,Villanueva C,Bush N.Primary and reoperative hypospadias repair in adults-are results different than in children?[J].J Urol,2014,192(6):1730-1733.DOI:10.1016/j.juro.2014.07.012.
Memo
收稿日期:2022-2-7。
基金项目:国家重点研发项目(2016YFC1000800)
通讯作者:张潍平,Email:zhangwp59616406@126.com