Risk factors for failed urethrocutaneous fistula repair after transverse preputial island flap urethroplasty in pediatric hypospadias.

Abstract

We review our experience in urethrocutaneous fistula (UCF) repair after transverse preputial island flap urethroplasty (Duckett) in pediatric hypospadias to investigate the risk factors for unsuccessful outcome. Two hundred and nineteen UCFs repairs conducted in our center from January 2015 to December 2016 after Duckett technique were retrospectively reviewed and 182 had a follow-up for more than 6months. The age of patients, size, localization and numbers of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCFs, hospital of primary surgery and postoperative infection were analyzed as potential risk factors. Stratified analysis and assessment of additive interaction were performed to have a better understanding of the relation between the risk factors. Logistic regression analysis was used for multivariate analysis. UCF repairs were succeeded in 121 (66.5%) and failed in 61 (33.5%) at first operation. In the univariate analysis, size and numbers of UCFs (P=0.01 and P=0.035, respectively), interval time of two operations (P=0.042) and hospital of primary surgery (P=0.02) were statistically related with the outcome. In the multivariate analysis, UCF≥2 (OR 2.71, 95%, CI 1.095-6.692, P=0.031), size ≥2mm (OR 2.45, 95% CI 1.267-4.757, P=0.08) and primary surgery not at our hospital (OR 2.21, 95% CI 1.094-4.126, P=0.026) were identified as independent risk factors for unsuccessful outcome. In the stratified analysis, multiplicative interaction between the 3 risk factors was not found. Our study suggested that UCF repairs after transverse preputial island flap urethroplasty were easier to fail if the UCF was ≥2mm, the numbers of UCFs was ≥2, or the surgeon had less experience. The age of patients, site of UCFs, interval time of two operations, length of neourethra, times of UCFs repairs, complications other than UCF and postoperative infection were not significantly related to the success rate of UCF repair.