Hu Jianjun,Zhao Yaowang,Chen Yifu,et al.Analysis of risk factors for postoperative complications of urethroplasty in children with disorders of sex development after male gender reassignment[J].Journal of Clinical Pediatric Surgery,,():534-540.[doi:10.3760/cma.j.cn101785-20260328-00141]
Analysis of risk factors for postoperative complications of urethroplasty in children with disorders of sex development after male gender reassignment
- Keywords:
- Disorder of Sex Development; Urogenital Surgical Procedures; Treatment Outcome; Postoperative Complications; Risk Factors
- Abstract:
- Objective To explore the risk factors for postoperative complications after urethroplasty in children with disorders of sex development (DSD) after male gender reassignment and provide references for optimizing clinical management strategies and lowering the incidence of complications. Methods The relevant clinical data were retrospectively reviewed for 60 DSD children undergoing urethroplasty for male gender reassignment from April 2021 to December 2024.The incidence of postoperative complications was statistically summarized.Univariate analysis was used for screening the relevant factors (P<0.20).And screened factors were included into multivariate Logistic regression model for identifying independent risk factors.The receiver operating characteristic (ROC) curve was applied for determining the optimal cut-off value of urethral defect length for predicting postoperative complications. Results Postoperative complications occurred in 19 cases.Surgical success was achieved in 41 cases with a complication incidence of 31.7%.The major types of complications included fistula (n=6),meatal stenosis (n=2),anastomotic stenosis (n=2),urethral diverticulum (n=1),urethral stenosis combined with urethral diverticulum (n=4) and incision infection (n=4).Univariate analysis indicated that urethral defect length alone was significantly correlated with postoperative complications (Z=-2.840,P=0.005).No significant correlations existed among age,glanular width,gonadal type,karyotype or the occurrence of complications (all P>0.05).Multivariate Logistic regression analysis confirmed that urethral defect length was an independent risk factor for postoperative complications (OR=1.865,95%CI:1.222-2.848,P=0.004).Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of urethral defect length for predicting postoperative complications was 0.729 (95%CI:0.578-0.881,P=0.005) with an optimal cut-off value of 4.90 cm,a sensitivity of 0.684,a specificity of 0.829 and a Youden index of 0.513.In conjunctions with comprehensive clinical practices,5.00 cm was determined as a clinically applicable critical value. Conclusion Urethral defect length is an independent risk factor for postoperative complications of urethroplasty in DSD children after male gender reassignment.The risk of postoperative complications spikes greatly when urethral defect length is ≥5.0 cm.Clinically,urethral defect length should be regarded as a core evaluation indicator.Individualized surgical protocols and enhanced perioperative management should be formulated for high-risk children for better outcomes.
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Memo
收稿日期:2026-3-28。
基金项目:国家临床重点专科培育项目-泌尿外科
通讯作者:赵夭望,Email:yw508@sina.com