Liu Yu,Qin Daorui,Wang Xuejun,et al.Analysis of related factors of complications after tubularized incised plate for initial hypospadias: a single-center report of 309 cases[J].Journal of Clinical Pediatric Surgery,,19():1094-1099.[doi:10.3969/j.issn.1671-6353.2020.12.007]
Click Copy

Analysis of related factors of complications after tubularized incised plate for initial hypospadias: a single-center report of 309 cases

Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R] volume: 第19卷 Number: 2020 12 Page: 1094-1099 Column: 专题 Date of publication: 2020-12-15
Author(s):
Liu Yu1;  Qin Daorui2;  Wang Xuejun2;  Mao Yu2;  Chen Shaoji2;  Tang Yunman2
1. Zunyi Medical University, Zunyi 610036, China;
2. Sichuan Academy of Medical Sciences. Department of Pediatric Surgery, Children’s Medical Center, Sichuan Provincial People’s Hospital, Chengdu 610072, China
Keywords:
Hypospadias/SU; Treatment Outcome; Postoperative Complications; Fenis/AB
CLC:
R726.9;R697+.11;R695
DOI:
10.3969/j.issn.1671-6353.2020.12.007
Abstract:
Objective To retrospectively analyze the clinical and follow-up data of children with hypospadias undergoing initial urethroplasty with Snodgrass or tubularized incised plate (TIP) and summarize the risk factors for complications after TIP.Methods Between September 2010 and November 2014,retrospective analysis was performed for 309 TIP children.Operative age,degree of hypospadias parting,penile curvature,urethra length,head width,covering material,penile width of navicular groove,coil tube width widths of urethral and urine tube type were recorded for multi-variable Logistic regression analysis.Results During a mean follow-up period of 4 years,postoperative complications occurred in 60 children (19.4%),including penile head depravation (n=17,5.5%),urinary fistula (n=33,10.7%),urethral stricture (n=9,2.9%),postoperative residual flexion (n=3,0.97%) and urethral diverticulum (n=1,0.32%).And 3 cases of penile head depravation and urinary fistula occurred simultaneously.After single factor analysis,widths of urethral plate,navicular groove and roll tube were included into multi-variable Logistic regression analysis.Width of navicular groove was an independent risk factor for postoperative complications (P<0.05).And width of navicular groove and TIP were negatively correlated with the risk of postoperative complications (P=0.011,OR=0.73).Specifically 1 mm rise of width of navicular groove had a 27% lower risk of postoperative complications.According to the ROC curve (AUC=0.611,P=0.008),the threshold value of 4.25 mm was obtained at a maximal Jorden index (Jorden index=0.18).The risk of postoperative complications in children with width of anavicular groove<4.25 mm was 2.082 folds that in those with a larger width (P=0.015,OR=2.082).Conclusion Width of navicular groove is an important influencing factor of postoperative complications after an initial TIP for hypospadias.Therefore width of navicular groove should be stressed for children undergoing TIP,especially for those with width of navicular groove<4.25 mm.Performing TIP alone is not advisable.

References:

1 宋宏程.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.issn0253-3006.2018.12.002. Song CH.Expert Consensus on Hypospadias[J].Chin J Pediatr Surg,2018,39(12):883-888.DOI:10.3760/cma.j.issn 0253-3006.2018.12.002.
2 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.
3 Mousavi SA,Aarabi M.Tubularized incised plate urethroplasty for hypospadias reoperation:a review and meta-analysis[J].Int Braz J Urol,2014,40(5):588-595.DOI:10.1590/S1677-5538.IBJU.2014.05.02.
4 Pfistermuller KL,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.
5 Cimador M,Vallasciani S,Manzoni G,et al.Failed hypospadias in paediatric patients[J].Nat Rev Urol,2013,10(11):657-666.DOI:10.1038/nrurol.2013.164.
6 Holland AJ,Smith GH.Effect of the depth and width of the urethral plate on tubularized incised plate urethroplasty[J].J Urol,2000,164(2):489-491.
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-e6.DOI:10.1016/j.jpurol.2017.05.020.
8 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.e3555.DOI:10.1016/j.jpurol.2015.05.029.
9 Faasse MA,Johnson EK,Bowen DK,et al.Is glans penis width a risk factor for complications after hypospadias repair?[J].J Pediatr Urol,2016,12(4):202.e1-e5.DOI:10.1016/j.jpurol.2016.04.017.
10 贾幸,谢华.尿道下裂阴茎下弯的组织学和手术治疗研究进展[J].临床小儿外科杂志,2019,18(9):795-799,802.DOI:10.3969/j.issn.1671-6353.2019.09.018. Jia X,Xie H.Research advances in histology and surgery of ventral penile curvature in hypospadias[J].J Clin Ped Sur,2019,18(9):795-799,802.DOI:10.3969/j.issn.1671-6353.2019.09.018.
11 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.
12 Snodgrass W,Bush N.Recent advances in understanding/management of hypospadias[J].F1000Prime Rep,2014,6:101.DOI:10.12703/P6-101.
13 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.
14 Snodgrass W,Koyle M,Manzoni G,et al.Tubularized incised plate hypospadias repair for proximal hypospadias[J].J Urol,1998,159(6):2129-2131.
15 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.
16 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.
17 Spinoit AF,Radford A,Ashraf J,et al.Modified tubularized incised plate urethroplasty in distal hypospadias repair:Stepwise technique with validated functional and cosmetic outcome[J].J Pediatr Urol,2017,13(1):86-87.DOI:10.1016/j.jpurol.2016.09.014.
18 Chung JW,Choi SH,Kim BS,et al.Risk factors for the development of urethrocutaneous fistula after hypospadias repair:a retrospective study[J].Korean J Urol,2012,53(10):711-715.DOI:10.4111/kju.2012.53.10.711.
19 Aboutaleb H.Role of the urethral plate characters in the success of tubularized incised plate urethroplasty[J].Indian J Plast Surg,2014,47(2):227-231.DOI:10.4103/0970-0358.138956.
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 Chukwubuike KE,Obianyo NEN,Ekenze SO,et al.Assessment of the effect of urethral plate width on outcome of hypospadias repair[J].J Pediatr Urol,2019,15(6):627.e1-e6.DOI:10.1016/j.jpurol.2019.09.019.
22 Nguyen MT,Snodgrass WT,Zaontz MR.Effect of urethral plate characteristics on tubularized incised plate urethroplasty[J].J Urol,2004,171(3):1260-1262.DOI:10.1097/01.ju.0000110426.32005.91.
23 冯超,张炯,谢弘,等.带蒂岛状转位筋膜皮瓣治疗尿道外口及舟状窝狭窄的临床研究[J].中华泌尿外科杂志,2019,40(6):408-411.DOI:10.3760/cma.j.issn.1000-6702.2019.06.003. Feng C,Zhang J,Xie H,et al.Clinical study of transverse island fasciocutaneous fascia flap for meatus and navicularfossa stricture[J].Chin J Urol,2019,40(6):408-411.DOI:10.3760/cma.j.issn.1000-6702.2019.06.003.
24 Dhua AK,Anand S,Agarwala S,et al.Comparison of anatomical landmarks and dimensions in a hypospadiac glans with those of a normal glans[J].J Indian Assoc Pediatr Surg,2018,23(3):144-147.DOI:10.4103/jiaps.JIAPS_151_17.

Memo

收稿日期:2020-08-06。
基金项目:四川省卫生健康委员会（编号：150206）
通讯作者:唐耘熳,Email:tangyunman@126.com

Last Update: 1900-01-01