Li Jie,Wang Yanze,Du Guoqiang,et al.Risk factor analysis of urethral obstruction after tubularized incised plate urethroplasty for hypospadias[J].Journal of Clinical Pediatric Surgery,2026,(02):153-158.[doi:10.3760/cma.j.cn101785-202509031]
尿道下裂行尿道板纵切卷管尿道成形术后尿道梗阻的危险因素分析
- Title:
- Risk factor analysis of urethral obstruction after tubularized incised plate urethroplasty for hypospadias
- 关键词:
- 尿道下裂; 尿道板纵切卷管尿道成形术; 尿道梗阻; 危险因素
- 摘要:
- 目的 探讨尿道下裂行尿道板纵切卷管尿道成形术(tubularized incised plate urethroplasty,TIP)后发生尿道梗阻的相关危险因素。方法 本研究为病例对照研究,收集2019年1月至2022年12月在山东第一医科大学附属省立医院小儿泌尿外科初次接受TIP手术治疗的253例尿道下裂患儿临床资料,包括术前尿道外口位置、阴茎头宽度、阴茎头处尿道板宽度、阴茎下弯角度、切开后尿道板宽度、成形尿道长度、留置尿管型号、随访时冠口距和尿道外口长度,以及术后排尿情况及发生尿道梗阻后处理情况。根据是否发生尿道梗阻分成尿道梗阻组和无尿道梗阻组,比较两组临床指标差异,并通过单因素及多因素Logistic回归分析筛选发生尿道梗阻的独立危险因素。结果 无尿道梗阻组185例;尿道梗阻组68例,其中真性梗阻39例,无排尿费力症状但尿线细29例。单因素分析显示,两组阴茎头处尿道板宽度(P=0.005)、脱套后阴茎下弯角度(P=0.004)、成形尿道长度(P<0.001),以及随访时冠口距(P=0.012)和尿道外口长度(P<0.001)差异均具有统计学意义(P<0.05)。多因素分析显示,阴茎头处尿道板宽度(P=0.015)、成形尿道长度(P=0.037)及随访时尿道外口长度(P<0.001)是TIP手术后发生尿道梗阻的独立危险因素。受试者操作特征曲线分析显示,阴茎头处尿道板宽度、成形尿道长度及随访时尿道外口长度预测TIP手术后发生尿道梗阻的最佳截断值分别为6.5 mm、15.5 mm和3.5 mm。结论 阴茎头处尿道板宽度＜6.5 mm、成形尿道长度＞15.5 mm及随访时尿道外口长度＜3.5 mm是尿道下裂TIP手术后发生尿道梗阻的独立危险因素,对于阴茎头处尿道板发育较差及近端型尿道下裂应慎重选择TIP术式,手术时应注意确保阴茎头段尿道通畅和尿道外口的适度宽大。
- Abstract:
- Objective To explore the risk factors associated with urethral obstruction after tubularized incised plate urethroplasty (TIP) for hypospadias. Methods This was a retrospective case-control study.Clinical data of 253 children with hypospadias who underwent primary TIP surgery in the Department of Pediatric Urology,Shandong Provincial Hospital Affiliated to Shandong First Medical University between January 2019 and December 2022 were collected.The data included preoperative meatal location,glans width,urethral plate width at the glans,degree of penile curvature,length of the reconstructed urethra,size of the indwelling catheter,coronal-meatal distance and meatal length at follow-up,as well as postoperative voiding status and management after the occurrence of urethral obstruction.According to whether urethral obstruction occurred,patients were divided into a urethral obstruction group and a non-urethral obstruction group.Differences in clinical indicators between the two groups were compared,and univariate and multivariate logistic regression analyses were performed to identify independent risk factors for urethral obstruction. Results There were 185 cases in the non-urethral obstruction group and 68 cases in the urethral obstruction group,including 39 cases of true obstruction and 29 cases with no symptoms of voiding difficulty but a thin urinary stream.Univariate analysis showed that urethral plate width at the glans (P=0.005),degree of penile curvature after degloving (P=0.004),length of the reconstructed urethra (P<0.001),as well as coronal-meatal distance (P=0.012) and meatal length at follow-up (P<0.001) differed significantly between the two groups (P<0.05).Multivariable analysis showed that urethral plate width at the glans (P=0.015),length of the reconstructed urethra (P=0.037),and meatal length at follow-up (P<0.001) were independent risk factors for urethral obstruction after TIP surgery.Receiver operating characteristic analysis showed that the optimal cutoff values of urethral plate width at the glans,length of the reconstructed urethra,and meatal length at follow-up for predicting urethral obstruction after TIP surgery were 6.5 mm,15.5 mm,and 3.5 mm,respectively. Conclusions Urethral plate width at the glans<6.5 mm,length of the reconstructed urethra>15.5 mm,and meatal length at follow-up<3.5 mm are independent risk factors for urethral obstruction after TIP surgery for hypospadias.TIP should be selected with caution in patients with poorly developed urethral plates at the glans and proximal hypospadias,and attention should be paid during surgery to ensuring patency of the glanular urethra and an adequate wide urethral meatus.
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备注/Memo
收稿日期:2025-9-14。
通讯作者:刘伟,Email:lemontree1119@126.com