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

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.