Development of a clinical prediction model for postoperative complications following tubularized incised plate urethroplasty: a multicenter study.

IF 1.6 3区医学 Q2 PEDIATRICS Pediatric Surgery International Pub Date : 2025-04-08 DOI:10.1007/s00383-025-06009-7

YiWei Fang, Dan Yang, Ning Sun, HongChen Song, WeiPing Zhang, YunMan Tang, LuGang Huang, Yi Yang, Min Chao, Hong Ma, JingTi Zhang, XuHui Zhang, ShouLin Li, Ning Li, Chao Chen, DaWei He, WenBo Wu, Hua Xie, Yong Guan, Yanfang Yang, Jianguo Zhang

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Abstract

Purpose: This multicenter study aimed to identify risk factors for postoperative complications following tubularized incised plate urethroplasty (TIP) in hypospadias patients and develop a clinical prediction model.

Methods: Retrospective data from 17 tertiary centers (2018-2021) were analyzed.

Inclusion criteria: primary TIP surgery with complete anatomical and follow-up data.

Exclusion criteria: prior urethral surgery, genetic disorders, or incomplete records. Multivariate logistic regression identified independent predictors. A nomogram model was constructed and internally validated using bootstrapping (1000 resamples). Discrimination (AUC) and calibration (Hosmer-Lemeshow test) were assessed.

Results: Among 493 patients (median follow-up: 42 months), the complication rate was 23.7% (117/493), including urethrocutaneous fistula (17.6%), stricture (6.5%), and diverticulum (2.8%). Independent predictors were: post-incision urethral plate width (OR: 0.01, 95% CI 0-0.05), glans width (OR: 0.81, 95% CI 0.66-0.98), and urethral defect length (OR: 1.47, 95% CI 1.00-2.16). The nomogram demonstrated moderate discrimination (AUC: 0.723, 95% CI 0.668-0.777) and good calibration (Hosmer-Lemeshow P = 0.382).

Conclusion: A clinical prediction model incorporating post-incision urethral plate width, glans width, and urethral defect length showed acceptable predictive accuracy for TIP complications.

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管状切开钢板尿道成形术术后并发症临床预测模型的建立：一项多中心研究。

目的：本多中心研究旨在确定尿道下裂患者行管状切开钢板尿道成形术（TIP）后并发症的危险因素，并建立临床预测模型。方法：回顾性分析2017 -2021年17个三级中心的数据。纳入标准：有完整解剖和随访资料的原发性TIP手术。排除标准：既往尿道手术、遗传疾病或记录不完整。多元逻辑回归确定了独立的预测因子。构建了一个nomogram模型，并使用bootstrapping（1000个样本）进行了内部验证。评定鉴别（AUC）和校正（Hosmer-Lemeshow检验）。结果：493例患者中位随访42个月，并发症发生率为23.7%(117/493)，包括尿道瘘（17.6%）、狭窄（6.5%）、憩室（2.8%）。独立预测因子为：切开后尿道板宽度（OR: 0.01, 95% CI 0-0.05）、龟头宽度（OR: 0.81, 95% CI 0.66-0.98）和尿道缺损长度（OR: 1.47, 95% CI 1.00-2.16）。nomogram显示中度判别（AUC: 0.723, 95% CI 0.668-0.777）和良好的校准（Hosmer-Lemeshow P = 0.382）。结论：结合切开后尿道板宽度、龟头宽度和尿道缺损长度的临床预测模型对TIP并发症的预测精度可接受。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Surgery International 医学-外科

CiteScore

3.00

自引率

5.60%

发文量

215

审稿时长

3-6 weeks

期刊介绍： Pediatric Surgery International is a journal devoted to the publication of new and important information from the entire spectrum of pediatric surgery. The major purpose of the journal is to promote postgraduate training and further education in the surgery of infants and children. The contents will include articles in clinical and experimental surgery, as well as related fields. One section of each issue is devoted to a special topic, with invited contributions from recognized authorities. Other sections will include: -Review articles- Original articles- Technical innovations- Letters to the editor