Risk Of Urethral Skin Fistula After Stage I Hypospadias Urethroplasty Development And Evaluation Of A Predictive Model For Columnar Maps

Objective To investigate the risk factors associated with the occurrence of urethral skin fistula after stage I hypospadiasplasty,to establish a columnar graph prediction model for the occurrence of urethral skin fistula and to evaluate its efficacy,and to provide assistance in the prevention of urethral skin fistula after hypospadiasplasty.Methods 1.Children who underwent hypospadias urethroplasty in stage Ⅰ from January 2017 to December 2021 in the Department of Pediatric Surgery,Ning Xia Medical University General Hospital were retrospectively selected by the same physician who reached the stable stage in the learning curve of pediatric urologists as the operator.2.Data were collected on the age of the child at surgery,disease staging,penile development size,penile curvature,anesthesia,surgical approach,urethral plate formation length,urethral tube type,intraoperative bleeding,season of surgery,urinary extravasation,infection,time of antibiotic use,time of postoperative urethral tube removal,and use of dressing in the operative area,etc.The children were followed up for 6 months after surgery.3.Univariate and multifactorial analyses of risk factors associated with urethral fistula were performed using logistic regression models to identify factors that have an independent effect on the occurrence of urethral fistula.The R software was applied to build a column line graph model for predicting the risk of developing urethral fistula,and the internal validation of the model was performed by Bootstrap method and the external validation by validation set,and the predictive performance of the column line graph was evaluated by using C-index,Calibration correction curve and ROC curve.Results 1.A total of 283 children were included in this study.The mean age of the included children was 4,67(0.83-16)years,and 142 cases of postoperative urethral skin fistula occurred,with an incidence of 50.1%.The univariate results showed that age,staging,glans diameter,degree of penile curvature,mode of anesthesia,length of plication,urethral tube type,intraoperative bleeding,season of surgery,urinary extravasation,infection,antibiotics when used,time of urethral tube removal,dressing material,and time of surgery were statistically associated with the occurrence of urethral fistula after stage I urethroplasty(P<0.05),and the multifactorial results showed that age,glans diameter,penile degree of curvature,intraoperative bleeding,urinary extravasation,and infection were independent risk factors for the occurrence of urethral fistula after stage Ⅰ urethroplasty.2,The ROC curve was 0.956 after the prediction model was established.six predictors were included based on Lassologistic regression analysis,and the predicted values were basically consistent with the measured values,indicating that the column line graph prediction model in this study has good predictive ability.In addition,this study used Bootstrap internal validation method to validate the model,indicating that the column line graph model of this study has good accuracy and differentiation.3.This study constructs a visualized urethral fistula occurrence risk score column line graph,incorporating six predictors of age,glans diameter,degree of penile curvature,intraoperative bleeding,urinary extravasation,and infection,which can be used for rapid assessment of urethral skin fistula occurrence risk after stage Ⅰ urethroplasty based on the condition of these predictors.Conclusion The study found a high incidence of urethral fistula after stage Ⅰ urethroplasty in Ningxia,and the model results showed that age,glans diameter,penile curvature,intraoperative bleeding,urinary extravasation,and infection were independent risk factors for the occurrence of urethral fistula,and preoperative measures need to be taken for prevention to reduce the risk of urethral fistula,and the visualized column line diagram can be used by clinicians for more visual reference and to provide prevention strategies for children with hypospadias.The visualization of the line drawings can be used by clinicians for visual reference and to provide prevention strategies for children with suburethral cleft.