Seguier-Lipszyc Emmanuelle, Beberashvili Ilia, Shumaker Andrew, Stav Kobi, Neheman Amos
Director of the Department of Pediatric Surgery, Meir Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Kfar Saba, Israel.
Division of Nephrology, Shamir Medical Center, Faculty of Medical and Health Sciences, Tel Aviv University, Zerifin, Israel.
J Paediatr Child Health. 2025 Sep;61(9):1452-1459. doi: 10.1111/jpc.70138. Epub 2025 Jul 8.
We assessed multiple clinical and anthropometric risk factors for urethroplasty complications requiring ancillary procedures following primary hypospadias repair.
It is a prospective cohort study of boys undergoing primary hypospadias repair comparing the group of patients with urethroplasty complication (UC) who required ancillary procedure to those without complication. Anthropometric parameters were obtained intraoperatively using a calliper and goniometer. In order to describe the discrimination ability of the potential predictors for UC, the areas under the Receiver Operating characteristic (ROC) curves were computed and univariate and multivariate logistic regression analyses were performed.
The study population consisted of 108 patients. Meatal location was sub-coronal, shaft, and proximal in 71 (66%), 28 (26%), and 9 (8%) cases respectively. Urethroplasty complications developed in 27 (25%) patients: 13 meatal stenosis, 10 fistula, and 7 dehiscence. By univariate logistic regression analysis, mal-developed urethral plate, two-stage urethroplasty, severe chordee (30° vs. 15°) and longer distance between the native meatus and the desired meatal location (11.5 mm vs. 8 mm) were significant predictors of UC. However, only meatal location (sub-coronal, shaft or proximal) stood to multivariable adjustments. The area under the ROC curve for meatal distance (p = 0.001) exhibited a good discrimination ability in assessing the risk for complications. Meatal distance above 9.5 mm was associated with an OR of 5.6 (p = 0.002) in predicting complications.
In our study, the only significant independent predictive factor for urethroplasty complications was found to be meatal location. Surgical outcomes were not influenced by objectively measured parameters of the glans or the degree of chordee.
我们评估了初次尿道下裂修复术后需要辅助手术的尿道成形术并发症的多种临床和人体测量学风险因素。
这是一项对接受初次尿道下裂修复术的男孩进行的前瞻性队列研究，比较了需要辅助手术的尿道成形术并发症（UC）患者组和无并发症患者组。术中使用卡尺和量角器获取人体测量参数。为了描述UC潜在预测因素的辨别能力，计算了受试者操作特征（ROC）曲线下的面积，并进行了单变量和多变量逻辑回归分析。
研究人群包括108例患者。尿道口位置分别为冠状沟下、阴茎体和近端，分别有71例（66%）、28例（26%）和9例（8%）。27例（25%）患者发生尿道成形术并发症：13例尿道口狭窄，10例瘘管，7例裂开。通过单变量逻辑回归分析，尿道板发育不良、两阶段尿道成形术、严重阴茎下弯（30°对15°）以及天然尿道口与期望尿道口位置之间的距离更长（11.5毫米对8毫米）是UC的显著预测因素。然而，只有尿道口位置（冠状沟下、阴茎体或近端）在多变量调整中仍然显著。尿道口距离的ROC曲线下面积（p = 0.001）在评估并发症风险方面表现出良好的辨别能力。预测并发症时，尿道口距离大于9.5毫米的OR为5.6（p = 0.002）。
在我们的研究中，发现尿道成形术并发症的唯一显著独立预测因素是尿道口位置。手术结果不受客观测量的龟头参数或阴茎下弯程度的影响。
