Analysis On The Factors Influencing The Short-term Surgical Results Of Hypospadias

PART Ⅰ Analysis of Multiple Factors Affecting the Outcome of Surgical Repair of HypospadiasObjective:Hypospadias has great individual differences,many repair methods,difficult operation and high incidence of complications.Through comprehensive analysis of many factors,this study summarized the factors that affect the effect of hypospadias surgery,and provided reference for preventing complications after hypospadias surgery and improving the cure rate of surgery.Methods:From June 2011 to October 2018,322 cases of hypospadias were collected from Department of Urology,Children’s Hospital of Soochow University.According to the outcome,the subjects were divided into two groups:the operation cure group and the operation improvement group.Through the comparative study of single factor and multifactor logistic regression analysis of related factors,the differences of each factor between the two groups were explored.Results:In single factor analysis,the types of hypospadias,degree of penile bending,operation methods,integrity of urethral plate,healing of incision,and staged operation had significant differences in different surgical effects(p<0.05).There was no significant difference in operative age among different surgical effects(p=0.705).In multivariate logistic regression analysis,the effect of anastomotic healing on surgical results was statistically significant(B=2.519,p<0.05);compared with posterior hypospadias,the effect of anterior hypospadias on surgical results was statistically significant(B=-0.952,p<0.05);compared with staged tubularised flap,the effect of MAGPI operation on surgical results was statistically significant(B=-2.736,p<0.05).There was no significant difference in the effect of other factors on the operation.In the correlation analysis,the operative methods were significantly correlated with the severity of hypospadias(r=0.618,p<0.05);the operative methods were significantly correlated with the stage operation(r=0.633,p<0.05);the operative methods were significantly correlated with the integrity of the urethral plate(r=0.705,p=p<0.05);the integrity of the urethral plate was highly correlated with the stage operation(r=0.875,p<0.05);The other factors were low or no correlation(r<0.5,p<0.05).Conclusion:The healing of incision after operation is an independent risk factor for the effect of operation;(2)Anterior hypospadias is an independent protective factor for the effect of operation compared with posterior hypospadias.(3)Surgical age had no significant effect on the outcome of surgery.(4)There were statistical differences in the age of operation between different groups.,but penile curvature is not an independent factor affecting the effect of surgery.(5)There were significant differences in the cure rate among different surgical methods,the integrity of urethral plate and whether or not the operation was performed by stages,but the above factors were not independent factors affecting the effect of the operation.(6)There are correlations among hypospadias type,operation method,integrity of urethral plate and operation stage,which together affect the operation effect.Part Ⅱ The Effect of Penile Developmental Condition in Preserving the Urethral Plate Surgery on Surgical ResultsObjective:In recent years,Preserving complete urethral plate as urethral repair material has been widely carried out in hypospadias surgery.This part of the study measured and statistically related penis development indicators in urethral plate reserving surgery,analyzed and summarized the influence of each indicator on the cure rate of surgery,and provided reference for the prediction of the cure rate of hypospadias surgery.Methods:From January 2015 to October 2018,204 hypospadias patients who underwent hypospadias reserving operation in Children’s Hospital of Soochow University were selected to measure the width of glans,the width of urethral plate,the degree of penile curvature and to record the developmental condition of urethral plate.The above research data were divided into cure group and unhealed group according to the effect of operation.A comparative study was conducted.To explore the impact of penile development indicators on surgical results.Results:Non-paranetric test showed that there were significant differences in the width of glans between different surgical effect groups(Z=-1.702,p=0.044).The subjects were grouped according to whether the width of the penile head was less than 1.4 cm,Chi-square test showed that there was significant difference in the surgical cure rate of different with of the glans(x2=4.398,p=0.036).There was no significant difference in the width of urethral plate between different groups.The subjects were grouped according to GMS score.There was significant difference in surgical cure rate among different groups(x2=12.288,p=0.002).Conclusions:1.The width of the penile head in the operation-cured group was significantly larger than that in the operation-unhealed group,and the cure rate of the operation with the width of the penile head greater than 1.4 cm was significantly higher than that of the operation with the width of the penile head less than 1.4 cm.2.There was no significant difference in the width of urethral plate between different surgical effects.3.GMS grading has an effect on the surgical outcome.The higher the grading,the lower the cure rate.