Risk factors for postoperative urethral diverticulum following hypospadias repair with disconnection of the urethral plate.

Abstract

Background: Urethral diverticulum (UD) may arise subsequent to hypospadias repair, potentially causing issues such as stone formation, frequent urination, urinary tract infections, urine dripping, and hematuria. We reviewed our previous experiences regarding hypospadias complications to identify the relevant factors affecting the occurrence of UD after hypospadias surgery and adjust management strategies accordingly.

Methods: A retrospective analysis was performed on the clinical data of 159 pediatric patients who underwent urethroplasty with disconnection of the urethral plate (DUP) in our department from January 2020 to December 2022. The collected information included patient demographics such as age, weight, Body Mass Index (BMI), Hemoglobin (Hb), Hematocrit (HCT), Albumin (ALB), Prealbumin (PALB), Procalcitonin (PCT), the employed surgical methods, whether the procedure was performed in stages, glans width, urethral stricture, penile curvature after correction, length of urethral defect, length of reconstructed urethra, indwelling catheter size and duration. The study population was divided into a group with UD and a group without UD, and univariate and multivariate analyses were performed.

Results: Among 159 patients with a mean follow-up of 31.87 ± 10.32 months, 14 (8.64%) patients developed UD after urethroplasty surgery. According to the univariate analysis, a narrower glans width (P = 0.018), a higher BMI (P = 0.019), the application of a modified onlay island flap (MOIF, P = 0.003), and urethral stricture (P = 0.010) were significantly associated with postoperative UD. Glans width (P = 0.023, OR = 0.444, 95% confidence interval [CI]: 0.220-0.895), BMI (P < 0.001, odds ratio [OR] = 1.808, 95% CI: 1.318-2.481), the application of MOIF (P = 0.007, OR = 10.670, 95% CI: 1.913-59.505) and urethral stricture (P = 0.015, OR = 10.010, 95% CI: 1.554-64.470) were independent factors for postoperative UD.

Conclusions: A narrower glans width, a higher BMI, the application of MOIF, and urethral stricture are significant factors contributing to the development of UD in patients with hypospadias following DUP.