Risk factor analysis for urethral stricture after hypospadias repair requiring urethral plate transaction

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.11.005

W. Ru, Zheming Xu, Yiding Shen, Hengyou Wang, Linfeng Zhu

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引用次数: 0

Abstract

Objective To explore the risk factors of urethral stricture after urethroplasty for hypospadias and to seek a more appropriate surgical strategy. Methods Clinical data were retrospectively analyzed for 429 cases undergoing primary hypospadias repair with urethral plate transection from February 2008 to October 2017.The mean age was 2.9 (0.3-17.5) years.The meatal location was penile-scrotal (n=349, 81.4%) and perineal (n=80, 18.6%). The operations were were performed by experienced (n=340, 79.3%) and novice surgeons (n=89, 20.7%). The surgical approaches included Duckett’s procedure (n=269, 62.7%), staged flap urethroplasty (n=98, 22.8%) and staged buccal mucosa tubularized tunnel urethroplasty (n=62, 14.5%). Results During a median follow-up period of 64 (14-125) months, there were urethral complications (n=173, 40.3%) and urethral stricture (n=58, 13.5%). Age, hypospadias type and surgical strategy varied widely among surgeons with different seniorities.Among less experienced surgeons, urethral stricture incidence rate was 23.1% during Duckett’s procedure and 5.6% during staged flap urethroplasty.As compared with Duckett’s procedure, staged flap urethroplasty lowered the risk of urethral stricture (OR 0.185, 95% CI 0.038-0.902, P<0.05). Among experienced surgeons, the incidence rate of urethral stricture was 10.1% during Duckett’s procedure, 8.1% during staged flap urethroplasty and 24.6% during staged buccal mucosa tubularized tunnel urethroplasty.As compared with Duckett’s procedure, staged buccal mucosa tubularized tunnel urethroplasty increased the risk of urethral stricture (OR 2.726, 95% CI 1.185-6.268, P<0.05) and staged flap urethroplasty offered no obvious advantage.Within each group, age or hypospadias type was not related with the occurrence of urethral stricture. Conclusions For severe hypospadias with urethral plate transaction, surgical strategy should be based upon surgeon seniorities.Suitable for novice surgeons, staged flap urethroplasty offers no advantage for experienced operators. Key words: Hypospadias; Urethral stricture; Postoperative complications; Urethral plate transection

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尿道下裂修补术后尿道狭窄需要尿道板置换的危险因素分析

目的探讨尿道下裂尿道成形术后尿道狭窄的危险因素，寻求更合适的手术策略。方法回顾性分析2008年2月至2017年10月行原发性尿道下裂尿道板横断修复术的429例患者的临床资料。平均年龄为2.9(0.3 ~ 17.5)岁。金属位置为阴茎阴囊(349例，81.4%)和会阴(80例，18.6%)。手术由经验丰富的外科医生(n=340, 79.3%)和新手(n=89, 20.7%)进行。手术入路包括Duckett手术(n=269，占62.7%)、分阶段皮瓣尿道成形术(n=98，占22.8%)和分阶段颊粘膜管状隧道尿道成形术(n=62，占14.5%)。结果中位随访64(14-125)个月，发生尿道并发症173例(40.3%)，尿道狭窄58例(13.5%)。年龄、尿道下裂类型和手术策略在不同资历的外科医生中差异很大。在经验不足的外科医生中，Duckett手术的尿道狭窄发生率为23.1%，分阶段皮瓣尿道成形术的尿道狭窄发生率为5.6%。与Duckett手术相比，分阶段皮瓣尿道成形术降低了尿道狭窄的风险(OR 0.185, 95% CI 0.038 ~ 0.902, P<0.05)。在经验丰富的外科医生中，Duckett术尿道狭窄发生率为10.1%，分阶段皮瓣尿道成形术为8.1%，分阶段颊粘膜管状隧道尿道成形术为24.6%。与Duckett方法相比，分阶段颊粘膜管状隧道尿道成形术增加了尿道狭窄的风险(OR 2.726, 95% CI 1.185 ~ 6.268, P<0.05)，分阶段皮瓣尿道成形术无明显优势。各组患者年龄、尿道下裂类型与尿道狭窄的发生无关。结论对于严重尿道下裂合并尿道板移位的患者，应根据术者的资历选择术式。适合新手外科医生，分阶段皮瓣尿道成形术对经验丰富的操作者没有优势。关键词:尿道下裂;尿道狭窄;术后并发症;尿道板横断

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.