尿道下裂尿道板纵切卷管尿道成形术后尿道狭窄危险因素分析

Analysis of risk factors for urethral stricture after hypospadias by tubularized incised plat urethroplasty

目的探讨尿道下裂尿道板纵切卷管尿道成形术(tubularized incised plat urethroplasty,TIP)后发生尿道狭窄的危险因素,以期提高尿道下裂的治疗效果。方法回顾性分析2019年1月至2022年1月安徽医科大学附属省儿童医院收治的首诊为尿道下裂且手术方式为TIP术式患儿的临床资料,并收集术后并发症情况及随访结果。符合纳入标准的患儿共190例,157例获完整随访,排除相关病例后最终纳入研究患儿共122例,患儿中位年龄为31个月;术前尿道开口于冠状沟处63例,阴茎体处38例,阴茎阴囊交界处21例;采用二分类logistic回归分析TIP术后尿道狭窄的潜在影响因素。结果所有患儿中,85例阴茎下弯≤35°,尿道板平整81例,矫正下弯后尿道缺损长度<2 cm有70例,83例阴茎头直径<1.4 cm;40例舟状窝宽度<4.25 mm;留置尿管时长14 d有21例,21 d有101例。患儿随访时间为7~43个月,随访成功率82.6%(157/190)。发生并发症59例(37.6%,59/157),其中尿道皮肤瘘32例(20.4%,32/157)、尿道狭窄28例(17.8%,28/157)、阴茎头裂开4例(2.5%,4/157)。对122例尿道下裂患儿TIP术后发生尿道狭窄的相关变量进行单因素分析发现,矫正阴茎下弯后尿道缺损长度<2 cm的患儿中8例发生术后狭窄,而≥2 cm的患儿中有16例,差异具有统计学意义(P=0.008);尿道板平整与欠光滑的患儿发生尿道狭窄分别为11例和13例(P=0.017);此外阴茎下弯程度(P=0.019)和舟状窝宽度(P=0.013)也是TIP术后尿道狭窄的危险因素。而手术时年龄、阴茎头直径、尿道开口位置及术后留置尿管时长与术后尿道狭窄无关(P>0.05)。多因素logistic回归分析结果显示,矫正阴茎下弯后尿道缺损长度(OR=0.333,95%CI:0.121~0.914)是TIP术后发生尿道狭窄的独立危险因素(P=0.033)。结论矫正阴茎下弯后尿道缺损长度是TIP术后发生尿道狭窄的重要影响因素,对于尿道缺损较大者需谨慎选择TIP术式。

Objective To explore the risk factors of urethral stricture after tubularized incised plat(TIP)urethroplasty for boosting the therapeutic efficacy of hypospadias.Methods From January 2019 to January 2022,the relevant clinical data were retrospectively reviewed for 190 children with hypospadias with a median age of 31 months.And postoperative complications and follow-up results were collected.Finally 122 children were recruited after excluding the related cases.Urethra opened preoperatively at coronal sulcus(n=63),penile shaft(n=38)and penile scrotal junction(n=21).Binary Logistic regression was employed for examining the potential risk factors of urethral stricture after TIP.Results There were penile curvature≤35°(n=85),urethral plate flatness(n=81),correction of posterior urethral defect length<2 cm(n=70),glans diameter<1.4 cm(n=83)and navicular fossa width<4.25 mm(n=40).The length of indwelling catheter for 14 days(n=21)and 21 days(n=101).During a follow-up period of(7-43)months,follow-up success rate was 82.6%(157/190).Complications occurred in 59 cases(59/157,37.6%),including urethral fistula(32/157,20.4%),urethral stricture(28/157,17.8%)and glans dehiscence(4/157,2.5%).Univariate analysis of the related variables of urethral stricture after TIP indicated that postoperative urethral stricture occurred in 8 children with posterior urethral defect length<2 cm after correcting hypospadias,while there were 16 children with≥2 cm,the difference was statistically significant(P=0.008).There were urethral stricture of flat urethral plate(n=11)and unsmooth urethral plate(n=13)(P=0.017).In addition,penile curvature(P=0.019)and navicular fossa width(P=0.013)were also risk factors for urethral stricture after TIP.Operative age,diameter of glans,position of urethral opening and postoperative duration of indwelling catheter were not related to postoperative urethral stricture(P>0.05).Multivariate Logistic regression analysis revealed that length of posterior urethral defect(OR=0.333,95%CI:0.121~0.914)was an independent risk factor for urethral stricture after TIP(P=0.033).Conclusions Length of posterior urethral defect after TIP is an important factor affecting the occurrence of urethral stricture.And TIP should be carefully selected children with larger urethral defect.