Hypospadias Duckett Postoperative Urinary Tube Length On The Influence Of The Incidence Of Postoperative Complications

Background:Hypospadias is a common urogenital tract malformation in male children.There are different reports on its incidence.The incidence is 1.86%in foreign reports,and 0.91%in domestic reports.The pathogenesis of hypospadias has not been fully clarified.At present,it is mainly believed that due to the hypoplasia of the anterior urethra,the reproductive tract of the urine is not completely closed from the posterior to the anterior midline during embryonic development,resulting in penile deformity in which the urethral opening cannot reach the normal position.Due to the hypoplasia of the penis and the anterior urethra,the urethral opening is abnormal and the penis is bent down,which leads to the inability of the children to urinate normally and reduces the adult sexual and reproductive function.The main clinical manifestations were ectopic urethral orifice,penile curvature and abnormal distribution of prepuce.Surgery is currently the only clinical treatment for hypospadias,but due to the specific anatomical structure and physiological limitations of the penis,the incidence of postoperative complications is high.This reduces the overall cure rate.The Expert consensus on hypospadias recommends that catheters should be reserved for 7 to 10 days after the operation of hypospadias.In recent years,some scholars have advocated that the removal of indwelling catheter after hypospadias surgery should be delayed to 4 weeks.But similar studies by other agencies have reported different results.Objective:The purpose of this study was to investigate the effect of length of indwelling urethral catheter on reducing postoperative complications of hypospadias.Combined with the actual situation of our hospital,to provide data support for the formulation of clinical diagnosis and treatment program.Methods:This study collected 181 children with hypospadias after Duckett urethroplasty in Children’s Hospital of Chongqing Medical University from January 2012 to October 2017.The patients were divided into two groups:group I had a postoperative catheter retention time of 5-9 days,and group II had a postoperative catheter retention time of 14-21 days.All included children were preschool children(<7 years old).Their average age is(3.03±0.10)years old.The chief surgeon has independently completed the operation of 200 cases of hypospadias or more than 10 years of clinical experience.It reached a stable stage in the learning curve of pediatric urologists.The postoperative treatment and nursing plan were the same.The operation season,operation age,pathological classification,duration of indwelling catheter and complications within 1 year after operation were recorded.Results:In this study,there were 9 cases of urinary fistula in group Ⅰ,and the incidence of urinary fistula was 15.79%.There were 19 cases of urinary fistula in group Ⅱ,and the incidence of urinary fistula was 15.32%.The difference between the two groups was not statistically significant(P=0.936>0.05).It is suggested that prolonging the duration of indwelling catheter has no significant effect on reducing the incidence of postoperative urinary fistula.Urethral stenosis occurred in 13 patients in group I,and the incidence of urethral stenosis was 22.81%.Urethral stenosis occurred in 14 patients in group Ⅱ,and the incidence of urethral stenosis was 11.29%.The difference between the two groups was statistically significant(P=0.044<0.05).It is suggested that prolonging the indwelling catheter time is significant to reduce the incidence of postoperative urethral stricture.There was no occurrence of urethral diverticulum in group I and 1 case of urethral diverticulum in group Ⅱ.Conclusion:Prolonged catheter indwelling after Duckett had no significant effect on the incidence of urinary fistula.Prolonged catheter indwelling after Duckett had a significant effect on reducing the incidence of urethral stricture.