Fang Yiwei,Song Hongcheng,Sun Ning,et al.Risk factors for short-term complications of hypospadias repair with transverse preputial island flap urethroplasty[J].Journal of Clinical Pediatric Surgery,,21():18-23.[doi:10.3760/cma.j.cn.101785-202107006-004]
Risk factors for short-term complications of hypospadias repair with transverse preputial island flap urethroplasty
- Keywords:
- Hypospadias/SU; Foreskin; Surgical Flaps; Postoperative Complications; Risk Factors; Treatment Outcome; Follow-Up Studies
- Abstract:
- Objective To explore the risk factors of postoperative complications of transverse preputial island flap urethroplasty (Duckett procedure), and to improve the treatment effect of hypospadias. Methods A retrospectively analysis was performed on the clinical and follow-up data of children with hypospadias undergoing operations of Duckett technique, staging Duckett technique or Duckett plus Duplay technique from December 2018 to December 2019.The information of short-term postoperative complications, including urethral fistula, urethral stricture and urethral diverticulum was collected.A multivariate analysis of risk factors for postoperative complications was performed. Results A total of 220 children were enrolled and divided into 3 groups:Duckett group (n=172), Duckett+Duplay group (n=20), and staging Duckett group (n=28).There are 208 cases who were followed up with the follow-up rate of 94.5% and mean follow-up time of 19 months.The complication rate was 49.5%(103/208), including 58 cases of urethral fistula (27.9%), 29 cases of urethral stricture (13.9%), 34 cases of urethral diverticulum dilation (16.3%), and 3 cases of recurrence/residual penile curvature (1.4%).Univariate analysis of Duckett group found that length of urethral defect (P=0.048), length of transverse preputial island flap (P=0.034), and location of urethral opening after correction of ventral curvature (P=0.027) were risk factors for postoperative complications of Duckett group.The patients’ age, length of penis, length and width of penis head, shape of foreskin, flatness and elasticity of skin flap, and distribution of superficial blood vessels in foreskin were irrelevant to postoperative complications (P>0.05).Multivariate Logistic analysis showed that length of urethal defect (OR=1.858, 95%CI:1.053~3.277) was an independent risk factor for postoperative complications after Duckett procedure (P=0.032). Conclusion Severe hypospadias entails difficult surgical treatment and high rate of postoperative complications.The length of urethral defect is an important factor influencing the complications of Duckett procedure.For children with hypospadias who have poor penile condition, it is feasible to perform staged surgery to reduce the operation difficulty and complication occurrence.
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Memo
收稿日期:2021-07-13。
基金项目:北京市医院管理局儿科协同发展专项子课题（XTZD20180303）
通讯作者:宋宏程,Email:songhch1975@126.com