Zhang Bin, Ruan Shuangsui, Bi Yunli
Department of Pediatric Urology, Children's Hospital of Fudan University, Shanghai, China.
Transl Androl Urol. 2021 Feb;10(2):703-709. doi: 10.21037/tau-20-1243.
Previous reports found that a preincision urethral plate (UP) width <8 mm increased the occurrence of urethroplasty complications (UCs) in tubularized incised plate (TIP) hypospadias repair. However, is the classification of the UP width based on an 8 mm cut-off value to predict the outcome of TIP urethroplasty objective enough or universally applicable? The purpose of our study was to assess the effect of the UP width on the outcomes of TIP hypospadias repair in the Eastern population we served.
We retrospectively reviewed the records of patients who underwent TIP hypospadias repair by the same surgeon between August 2013 and December 2019 in our hospital. Data were collected, including demographics, intrinsic parameters of the penis, surgical parameters and subsequent surgical outcomes. The data were analyzed and the cut-off value of the UP width was calculated using a receiving-operator curve.
Primary TIP urethroplasty was carried out in 116 patients with a mean age of 35.89±29.40 months. The meatal location was distal in 49 patients, midshaft in 56 patients and proximal in 11 patients. The mean glans width was 12.28±1.36 mm, the mean UP width was 5.74±1.37 mm, the mean neourethral length was 1.96±1.32 cm, and the mean operation duration was 87.52±11.47 min. During a median follow-up of 42 (range: 6 to 80) months, UCs developed in 12 patients, and the UP width was significantly related to the occurrence of UCs (P=0.014). According to the 6 mm cut-off value of the UP width by the receiver operating characteristic curve, patients were divided into two groups. Group A (UP width ≥6 mm) included 69 patients, and Group B (UP width <6 mm), 47 patients. UCs occurred in 3 patients in Group A vs. 9 patients in Group B, P=0.010.
UP width is a potential risk factor for UCs after TIP hypospadias repair. Using this technique with an UP width ≥6 mm is sufficient to result in a good outcome of hypospadias repair.
既往报道发现，在管状切开包皮板（TIP）法修复尿道下裂时，术前尿道板（UP）宽度<8 mm会增加尿道成形术并发症（UCs）的发生率。然而，基于8 mm的截断值对UP宽度进行分类以预测TIP尿道成形术的结果是否足够客观或普遍适用？我们研究的目的是评估UP宽度对我们所服务的东方人群中TIP尿道下裂修复结果的影响。
我们回顾性分析了2013年8月至2019年12月期间在我院由同一位外科医生进行TIP尿道下裂修复的患者记录。收集的数据包括人口统计学资料、阴茎的固有参数、手术参数及后续手术结果。对数据进行分析，并使用受试者工作特征曲线计算UP宽度的截断值。
116例患者接受了一期TIP尿道成形术，平均年龄为35.89±29.40个月。尿道口位置远端49例，阴茎体部56例，近端11例。平均龟头宽度为12.28±1.36 mm，平均UP宽度为5.74±1.37 mm，平均新尿道长度为1.96±1.32 cm，平均手术时间为87.52±11.47分钟。在中位随访42（范围：6至80）个月期间，12例患者发生了UCs，UP宽度与UCs的发生显著相关（P = 0.014）。根据受试者工作特征曲线得出的UP宽度6 mm截断值，将患者分为两组。A组（UP宽度≥6 mm）69例，B组（UP宽度<6 mm）47例。A组3例发生UCs，B组9例发生UCs，P = 0.010。
UP宽度是TIP尿道下裂修复术后发生UCs的一个潜在危险因素。使用该技术时，UP宽度≥6 mm足以获得良好的尿道下裂修复效果。
