Comparative Analysis Of Postoperative Complications And Risk Factors Of Proximal Hypospadias Treated By Different Surgical Methods

Objective:To compare the mid-term complications of proximal hypospadias after one and staged surgery,and then to analyze the risk factors affecting the occurrence of complications.Methods:262 children with proximal hypospadias admitted to the Department of Pediatric Urology,Shengjing Hospital Affiliated to China Medical University from January 2014 to December 2020 were retrospectively analyzed.Patients were divided into one stage operation group(192/262,73.3%)and staged operation group(70/262,26.7%).The one stage operation included the one stage Duckett group(172/192,90%)and the one stage Duckett combined Duplay group(20/192,10%).The staged operation was divided into the staged Byars flap group(54/70,77.1%)and the staged Duckett group(16/70,22.9%).IBMSPSS25 was used for statistical analysis to compare the differences of the complication rates between the one-stage operation group and the staged operation group and among each group.Logistics regression analysis was conducted to compare the risk factors affecting the occurrence of complications rates(P<0.05 was statistically significant).Results:Postoperative complications occurred in 71(71/192,36.9%)of 192 children undergoing one stage surgery,urethral fistula occurred in 37 cases(37/192,19.2%),including 5 cases with urethral stricture and 3 cases with urethral stricture and urethral diverticulum.Among the other children,20 cases had urethral stricture,4 cases had urethral stricture combined with urethral diverticulum,9 cases had urethral diverticulum,and 1 case had glans dehiscence.There was no obvious recurrence of ventral chordee of the penis.Of the 70 patients in the staged operation group,21 cases(21/70,30.0%)had complications after surgery,including urethral fistula in 18 cases(18/70,25.7%),urethral stricture in 2 cases(2/70,2.8%)and urethral diverticulum in 1 cases(1/70,1.4%).No urethral or glans dehiscence was observed,and no recurrence of ventral chordee of the penis.The rate of postoperative urethral stricture in the one stage operation group was significantly higher than that in the staged operation group(X~2=8.663,P=0.003).The incidence of urethral diverticulum in the one stage operation group was significantly higher than that in the staged operation group(X~2=4.421,P=0.036).The rate of urethral diverticulum in the one stage Duckett group was lower than that in the one stage Duckett combined Duplay group(X~2=7.212,P=0.007).The incidence of urethral stricture in the one stage Duckett group was higher than that in staged Byars flap group(X~2=8.440,P=0.004).The incidence of urethral diverticulum in the staged Duckett group was higher than that in the staged Byars flap group(X~2=3.979,P=0.046).The rate of urethral fistula in staged Byars flap group was higher than that in the staged Duckett group(X~2=4.114,P=0.043).The results of binary logistics regression analysis showed that:for one stage surgery,urethroplasty length is a risk factor contributed to postoperative complications(P=0.013),and the risk of postoperative complications increases 1.571(1.101-2.243)times for every 1cm increase in urethroplasty length.Vascular pedicle combined additional coverage of the formed urethra of staged surgery was a protective factor for postoperative complications(P=0.021,OR=0.085,CI(0.014-0.524)).Conclusion:The overall complication rate of proximal hypospadias was higher in one stage surgery than in staged surgery.For one stage surgery,urethroplasty length is a risk factor contributed to postoperative complications,and the risk of postoperative complications increases 1.571 times for every 1cm increase in urethroplasty length.For staged surgery,additional coverage of the newly formed urethra can reduce the incidence of postoperative complications.