| Objective To explore the risk factors of urethral stricture after tubularized incised plat urethroplasty(TIPU)in order to improve the therapeutic effect of hypospadias.Methods The clinical data and follow-up results of patients with hypospadias treated in the Provincial Children’s Hospital affiliated to Anhui Medical University from January 2019 to January 2022 were analyzed retrospectively,and the postoperative complications were collected.Binary Logistic regression was used to analyze the potential risk factors of urethral stricture after TIPU.Results: A total of 190 children who met the inclusion criteria.During the follow-up period of 7-43 months,157 cases were followed up,with a follow-up success rate of 82.6%.Complications occurred in 59 cases(59/ 157,37.6%),including 32 cases of urethral fistula(32/157,20.4%),28 cases of urethral stricture(28/157,17.8%)and 4 cases of penile head dehiscence(4/157,2.5%).After excluding the related cases,122 cases were included in the study.Univariate analysis showed that urethral defect length(P=0.008),urethral plate flatness(P=0.017),penile curvature(P=0.019)and navicular fossa width(P=0.013)were risk factors for urethral stricture after TIPU.The age at operation,the diameter of penile head,the position of urethral opening and the duration of indwelling catheter after operation were not related to postoperative urethral stricture(P > 0.05).Multivariate Logistic regression analysis showed that correcting the length of posterior urethral defect(OR=0.333,95%CI: 0.121~ 0.914)was an independent risk factor for urethral stricture after TIPU(P=0.033).Conclusion: Correcting the length of posterior urethral defect after TIPU is an important factor affecting the occurrence of urethral stricture.TIPU should be carefully chosen for patients with larger urethral defect.Objective To explore the application of uroflowmatry after hypospadias surgery in children,to observe the changes of uroflowmatry after hypospadias by TIPU,and to evaluate the voiding function after this operation..Methods The clinical data of patients with hypospadias who were first treated in the Department of Urology of Anhui Children’s Hospital from February 2020 to February 2023 were collected and analyzed.The postoperative complications were collected.The uroflowmatry of each patient was detected in the short term and long term after operation.Mann-Whitney U test was used to compare and analyze the changes of uroflowmetry related indexes after TIPU.Results: The total number of cases in this study was 48,and the patients with insufficient uroflowmatry were excluded according to the exclusion criteria,and finally 35 cases were included in the study.The average age was 3.46 ±2.79 years old.There were 17 cases of distal type,10 cases of intermediate type and 8cases of proximal type.According to the Toguri nomograms,in the recent uroflowmatry of 35 cases of hypospadias,the normal flow rate in 5 cases(14.3%),equivocally obstructed in 6 cases(17.1%),and obstructed flow rate in 24 cases(68.6%).The shape of urinary flow curve was smooth bell?shaped curve in 8 cases(22.9%),plateau curve in 22 cases(62.9%)and intermittent curve in 5 cases(14.3%).In the long-term free urinary flow rate test,the normal flow rate in 7 cases(20.0%),equivocally obstructed in 15 cases(42.9%),and obstructed flow rate in 13 cases(37.1%).The shape of urinary flow curve was smooth bell-shaped in 15cases(42.9%),plateau curve in 18cases(51.4%),and intermittent curve in only 2 cases(5.7%).There was significant difference between short-term and long-term Qmax and Qave after hypospadias operation(P=0.013,P=0.026),There was no significant difference in TQmax、uroflow rate at 2 second and acceleration(P > 0.05).There was no significant difference in the shape of urinary flow curve between shortterm and long-term after operation(P > 0.05).Conclusion: To sum up,the common feature of hypospadias after TIPU is that the uroflowmetry(Qmax)decreases significantly,but it will be significantly improved with the passage of time.For early equivocally obstructed or obstructed flow rate after hypospadias operation,we should observe and measure uroflow rate many times,make a comprehensive evaluation,and choose the intervention treatment carefully.Therefore,it is of certain clinical significance to uroflowmetry regularly after TIPU. |
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