Risk factor analysis for urethral stricture after hypospadias repair requiring urethral plate transaction

Objective To explore the risk factors of urethral stricture after urethroplasty for hypospadias and to seek a more appropriate surgical strategy. Methods Clinical data were retrospectively analyzed for 429 cases undergoing primary hypospadias repair with urethral plate transection from February 2008 to October 2017.The mean age was 2.9 (0.3-17.5) years.The meatal location was penile-scrotal (n=349, 81.4%) and perineal (n=80, 18.6%). The operations were were performed by experienced (n=340, 79.3%) and novice surgeons (n=89, 20.7%). The surgical approaches included Duckett’s procedure (n=269, 62.7%), staged flap urethroplasty (n=98, 22.8%) and staged buccal mucosa tubularized tunnel urethroplasty (n=62, 14.5%). Results During a median follow-up period of 64 (14-125) months, there were urethral complications (n=173, 40.3%) and urethral stricture (n=58, 13.5%). Age, hypospadias type and surgical strategy varied widely among surgeons with different seniorities.Among less experienced surgeons, urethral stricture incidence rate was 23.1% during Duckett’s procedure and 5.6% during staged flap urethroplasty.As compared with Duckett’s procedure, staged flap urethroplasty lowered the risk of urethral stricture (OR 0.185, 95% CI 0.038-0.902, P<0.05). Among experienced surgeons, the incidence rate of urethral stricture was 10.1% during Duckett’s procedure, 8.1% during staged flap urethroplasty and 24.6% during staged buccal mucosa tubularized tunnel urethroplasty.As compared with Duckett’s procedure, staged buccal mucosa tubularized tunnel urethroplasty increased the risk of urethral stricture (OR 2.726, 95% CI 1.185-6.268, P<0.05) and staged flap urethroplasty offered no obvious advantage.Within each group, age or hypospadias type was not related with the occurrence of urethral stricture. Conclusions For severe hypospadias with urethral plate transaction, surgical strategy should be based upon surgeon seniorities.Suitable for novice surgeons, staged flap urethroplasty offers no advantage for experienced operators. Key words: Hypospadias; Urethral stricture; Postoperative complications; Urethral plate transection