Yang Zhilin,Zhang Peiliang,He Yingying,et al.Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias[J].Journal of Clinical Pediatric Surgery,,():555-560.[doi:10.3760/cma.j.cn101785-202209022-009]
Impacts of glanular width and urethral plate width on tubularized incised plate urethroplasty complications in children with hypospadias
- Keywords:
- Hypospadias; Surgical Procedures; Operative; Penis; Urethra; Postoperative Complications; Root Cause Analysis
- Abstract:
- Objective To explore the impact factors of tubularized incised plate (TIP) urethroplasty complications Methods From January 2019 to June 2021,prospective review was conducted for 272 children with hypospadias undergoing TIP urethroplasty.Operative age,meatus location,urethral plate width,glans width,urethral defect,operative duration and postoperative complications of urethral fistula,urethral stricture and glanular dehiscence were recorded.They were assigned into two groups of complication and normal.Multi-factorial Logistic regression analysis was performed for examining the correlation of observation factors and postoperative complications.Results Mean age was 3.7(1-16) year.Glanular width was ≥13 mm (n=240) and <13 mm(n=35).Urethral width was <8 mm (n=224) and ≥8 mm (n=51).During a follow-up period of (1-3) year,17 children (6.2%) developed urethral complications of urethral fistulas (n=12),urethral stricture (n=2) and glanular dehiscence (n=4).No significant difference existed between children with urethral plate ≥8 mm and <8 mm [2/51(3.9%) vs.15/24(6.7%),P=0.448] .Complication rate was lower in children with glanular width ≥13 mm than those with glanular width <13 mm [3.8%(9/240) vs.8/35(22.9%),P=0.001].Univariate Logistic regression indicated that meatus location,glanular width,urethral defect and operative duration were potential impact factors.However,multiple Logistic regression revealed that glanular width was the only impact factor of postoperative complications.Conclusions Glanular width is a risk factor of postoperative complications after TIP urethroplasty.For glanular width under 13 mm,TIP repair is recommended without a consideration of urethral plate width.
References:
[1] Bergman JEH,Loane M,Vrijheid M,et al.Epidemiology of hypospadias in Europe:a registry-based study[J].World J Urol,2015,33(12):2159-2167.DOI:10.1007/s00345-015-1507-6.
[2] 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.
[3] Alshafei A,Cascio S,Boland F,et al.Comparing the outcomes of tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty in children with hypospadias:a systematic review and meta-analysis[J].J Pediatr Urol,2020,16(2):154-161.DOI:10.1016/j.jpurol.2020.01.009.
[4] Snodgrass WT.Tubularized incised plate (TIP) hypospadias repair[J].Urol Clin North Am,2002,29(2):285-290.DOI:10.1016/s0094-0143(02)00045-9.
[5] 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.
[6] Snodgrass WT,Nguyen MT.Current technique of tubularized incised plate hypospadias repair[J].Urology,2002,60(1):157-162.DOI:10.1016/s0090-4295(02)01620-5.
[7] Eldeeb M,Nagla S,Abou-Farha M,et al.Snodgrass vs snodgraft operation to repair the distal hypospadias in the narrow urethral plate[J].J Pediatr Urol,2020,16(2):165.e1-165.e8.DOI:10.1016/j.jpurol.2020.01.006.
[8] Sarhan OM,El-Hefnawy AS,Hafez AT,et al.Factors affecting outcome of tubularized incised plate (TIP) urethroplasty:single-center experience with 500 cases[J].J Pediatr Urol,2009,5(5):378-382.DOI:10.1016/j.jpurol.2009.02.204.
[9] Snodgrass W,Cost N,Nakonezny PA,et al.Analysis of risk factors for glans dehiscence after tubularized incised plate hypospadias repair[J].J Urol,2011,185(5):1845-1849.DOI:10.1016/j.juro.2010.12.070.
[10] Zhang B,Ruan SS,Bi YL.Urethral plate in tubularized incised plate urethroplasty:how wide is enough?[J].Transl Androl Urol,2021,10(2):703-709.DOI:10.21037/tau-20-1243.
[11] 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].DOI:10.3969/j.issn.1671-6353.2020.12.007.
[12] 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.
[13] 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.
[14] 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.
[15] 方一圩,宋宏程,孙宁,等.尿道下裂横裁带蒂包皮岛状皮瓣尿道成形术后近期并发症的危险因素分析[J].临床小儿外科杂志,2022,21(1):18-23.DOI:10.3760/cma.j.cn.101785-202107006-004. Fang YW,Song HC,Sun N,et al.Risk factors for short-term complications after transverse preputial island flap urethroplasty for hypospadias repairing[J].J Clin Ped Sur,2022,21(1):18-23.DOI:10.3760/cma.j.cn.101785-202107006-004.
[16] Viseshsindh W.Factors affecting results of hypospadias repair:single technique and surgeon[J].J Med Assoc Thai,2014,97(7):694-698.
[17] 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.
Memo
收稿日期:2022-09-15。
基金项目:广东省高水平医院建设专项经费资助(2020-2024);深圳市医学重点学科(SZXK035)
通信作者:李守林,Email:lishoulin83008088@163.com