Risk factors for complications after Duckett urethroplasty: Guiding the timing of staged hypospadias repair in children.

OBJECTIVE: To identify the risk factors for complications following the Duckett urethroplasty and to evaluate the predictive value for postoperative complications of both the risk factors and the predictive model incorporating them, with the goal of guiding intraoperative decision-making regarding staged hypospadias repair in children.

METHODS: A retrospective study was conducted involving 160 pediatric patients who underwent primary Duckett urethroplasty at our institution between January 2019 and January 2023. Univariate analysis was first performed to screen potential risk factors, followed by multivariate logistic regression to identify independent risk factors. Based on these independent risk factors, a predictive model was subsequently developed. Receiver operating characteristic (ROC) curve analysis was then applied to evaluate the predictive value of both the risk factors and the predictive model for complications following the Duckett urethroplasty.

RESULTS: Multivariate logistic regression analysis identified the degree of penile curvature (OR = 3.272; 95% CI [1.133-9.453]) and urethral defect length (OR = 3.555; 95% CI [1.836-6.885]) as independent risk factors for postoperative complications. The developed predictive model was formulated as: Logit(P) = -5.5 + 0.988 × (degree of penile curvature) + 1.177 × (urethral defect length). Both the urethral defect length alone and the predictive model incorporating both urethral defect length and the degree of penile curvature showed high predictive value for complications following the Duckett urethroplasty. The area under the curve (AUC) for urethral defect length was 0.806 (P < 0.001, 95% CI: 0.737-0.875), with a Youden index of 0.625, a sensitivity of 88.9%, a specificity of 73.6%, and an optimal cutoff value of 3.45. The AUC for the predictive model combining penile curvature and urethral defect length was 0.810 (P < 0.001, 95% CI: 0.740-0.879), with a Youden index of 0.598, a sensitivity of 81.5%, a specificity of 78.3%, and an optimal cutoff value of 0.39.

CONCLUSION: Both the predictive model integrating the degree of penile curvature with urethral defect length and the urethral defect length alone demonstrated high predictive value for complications following primary Duckett urethroplasty. Given that urethral defect length can be readily measured intraoperatively and offers strong clinical practicality, its use is recommended in practice for determining the timing of staged repair. Specifically, if the urethral defect length measures ≥3.5 cm after intraoperative correction of penile curvature, staged surgery should be considered in conjunction with the individual penile condition of the patient.