Tian Guangchao,Fan Yingzhong,Yuan Sitong,et al.Analysis of influencing factors of anastomotic stricture after Duckett operation for hypospadias[J].Journal of Clinical Pediatric Surgery,,21():445-451.[doi:10.3760/cma.j.cn101785-202110007-009]
Analysis of influencing factors of anastomotic stricture after Duckett operation for hypospadias
- Keywords:
- Hypospadias/SU; Hypospadias/CO; Surgical Stomas; Constriction; Pathologic; Urethral Stricture; Treatment Outcome; Comparative Study
- Abstract:
- Objective To explore the factors associated with stenosis of old and new urethral anastomo- sis after one-stage Duckett’s urethroplasty for hypospadias. Methods From January 2019 to January 2021,156 children of hypospadias with marked penile curvature were retrospectively recruited as study group. They were divided into two groups of stenosis and non-stenosis according to whether or not postoperative urethral anasto- motic stricture was complicated. The suspected factors associated with postoperative urethral anastomotic stric- ture included long/short bevel urethral anastomosis method, age, weight, operative duration, length of formed u- rethra, removal time of catheter, removal time of penile dressing, concomitant urethral fistula & urinary system comorbidity. Results Twenty-nine cases (29/156, 18. 59%) of anastomotic stricture occurred after urethro- plasty for hypospadias. Univariate analysis revealed that fewer cases of long-bevel urethral anastomosis were per formed in stenosis group[(n=9, 31. 0%) versus (n=65, 51. 2%), χ2=3. 843, P=0. 05] and there was a significantly higher incidence of postoperative urethral fistula[(n=18,62. 1%) versus (n=25,19. 7%), χ2=21. 241, P < 0. 001]. As compared with non-stenosis group, there was statistically significant difference. After multifactorial analysis, the factors associated with postoperative anastomotic strictures were long/short bevel ure- thral anastomosis method (P=0. 022) and postoperative complications of urethral fistula (P < 0. 001). Ure- thral dilation was performed under general anesthesia for urethral anastomotic stricture (n=29). An 8-10 Fr urethral catheter was inserted intraoperatively and removed at Month 1. Recurrent dysuria was absent (n=16) and present (n=12) at Days 2-3 after removing catheter. For the latter, ring incision with proximal anastomo- sis was performed under general anesthesia. Fistula was repaired at Months 6-10. In one child of recurrent dys- uria after catheter removal, artificial fistula was repaired 6 months after stenosis incising. During secondary ure- throplasty for recurrent dysuria, a needle-tip fistula in middle penis was cured at Month 6. Forty-three cases were complicated by postoperative urethral fistula and 40 cases cured after returning for urethral fistula repair at Months 6-10 months and 3 cases of urethral fistula were repaired. Conclusion After one-stage Duckett’s urethroplasty, long/short bevel urethral anastomosis is an independent factor of anastomotic stricture and long- bevel urethral anastomosis can effectively reduce the occurrence of postoperative anastomotic stricture.
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Memo
收稿日期:2021-10-5。
基金项目:河南省联合重点基金项目（SBGJ202002042）
通讯作者:范应中,Email:fanyingzhong2@163.com