Clinical Value of Microsurgery Combined with Covering New Urethra by Multilayer Sarcolemma Tissues in the Treatment of Hypospadias in Male Children and Analysis of Urodynamic Parameters

Clinical Value of Microsurgery Combined with Covering New Urethra by Multilayer Sarcolemma Tissues in the Treatment of Hypospadias in Male Children and Analysis of Urodynamic Parameters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Value of Microsurgery Combined with Covering New Urethra by Multilayer Sarcolemma Tissues in the Treatment of Hypospadias in Male Children and Analysis of Urodynamic Parameters Wei Zheng, Shi-lei Guo, Xiao-qing Shi, Jie Wang, Bo-song Zhang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3972667/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To compare and analyze differences in the clinical effect and postoperative urodynamic indexes of microsurgery combined with covering new urethra by multilayer sarcolemma tissues and conventional surgery alone in the treatment of male children with hypospadias. Methods A total of 80 male children with penile hypospadias who were hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital were randomly divided into two groups, with 40 in each group. Children in the study group underwent microsurgery combined with covering new urethra by multilayer sarcolemma tissues, while those in the control group were provided with traditional tubularized incised plate (TIP) urethroplasty alone. Further comparative analysis was performed on the operation effect, operation time, total intraoperative bleeding, postoperative length of stay in the hospital and the incidence of surgical complications between the two groups. All male children were followed up for 6 months to compare and analyze the changes of urodynamic parameters such as maximum urinary flow rate (Qmax), mean urinary flow rate (Qavc), post-void residual urine (PVR) before and after surgery. Results There were statistically significant differences that the operation time(p = 0.03) was longer while the postoperative length of stay in the hospital (p = 0.000) was shorter in the study group than those in the control group. The effective rate of the study group was 97.50%, while that of the control group was 82.50%, with statistically significant difference (p = 0.025). The incidence of surgical complications was 7.50% in the study group and 25.00% in the control group 3 months after operation (p = 0.034). There was statistically significant difference that the Hose score of the study group was significantly higher than that of the control group (p = 0.000). Meanwhile, there was no significant difference in indicators such as Qmax, Qavc and PVR between the two groups before surgery; while the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after surgery, with statistically significant difference (p = 0.000). Conclusion Microsurgery combined with covering new urethra by multilayer sarcolemma tissues has certain clinical value in the treatment of male children with hypospadias, which shows good therapeutic effect, shorter length of stay in the hospital, lower incidence of postoperative complications, and significantly improved urodynamic indicators, despite slightly complicated operation and relatively longer duration of operation. Covering by multilayer sarcolemma tissues Children Hypospadias Microsurgery Clinical effect Introduction Hypospadias has been recognized to be a common congenital malformation in Pediatric Urology. Children with hypospadias generally show ectopic position of the urethral orifice, chordee of penis and scarf-like changes in the dorsal foreskin of the penis [ 1 ]. It is a highly heterogeneous multifactorial disease, which may be attributed to multiple genetic and environmental factors [ 2 ]. Hypospadias is commonly treated by surgery to restore its appearance and function. It can be corrected at any age, without significant difference in the risk of complications, functional recovery and cosmetic effect. However, correction at an earlier stage is recommended by most researchers [ 3 ]. At present, there are many corrective operations for hypospadias, yet accompanied by relatively higher incidence of postoperative complications. The major surgical complications are postoperative urinary fistula, urethral stricture, and unsatisfactory appearance, with the highest rate of urinary fistula in particular [ 4 ]. Therefore, great concern in the treatment of hypospadias has been attached to the exploration of appropriate approaches to reduce the surgical complications. The construction of abundant tissue barriers between the newly established urethra and the skin is the key to the surgery for hypospadias, which can reduce the occurrence of postoperative urinary fistula and promote the healthy formation of the newly formed urethra [ 5 ]. With the continuous development of science and technology, initial success has been realized in the application of microscopy for the repair of hypospadias. Through microscopic operation, the direction of blood vessels can be clearly visualized to ensure good blood supply of the covered tissue, leading to an improved success rate of surgery and hence reduced incidence of postoperative complications [ 6 ]. With respect to the above, this study explored the combination of multilayer sarcolemma tissue to cover the new urethra and microsurgery to improve the surgery for hypospadias, so as to reduce the occurrence of postoperative complications, which are reported as follows: Materials and Methods Inclusion criteria:①male children who met the diagnostic criteria for penile hypospadias[7]; ②male children without obvious chordee of penis or with mild chordee of penis that required no surgical correction; ③male children with flat urethral plates that were ≥ 6mm in width and had good elasticity; ④male children with urethral orifice located at the distal end and in the middle of the penis; ⑤male children who aged ≤ 12 years old; ⑥male children without heart, lung and other important organ diseases and other surgical contraindications; ⑦male children with complete clinical data;⑧male children whose family members agreed to accept the study and signed the informed consent form; and ⑨male children without obvious symptoms of mental nervous system, with good treatment compliance, and those who could cooperate with the study. Exclusion criteria: ①male children with chordee of penis requiring surgical correction; ②male children with secondary surgical intervention; ③male children with urethral orifice at the junction of penis and scrotum; ④male children with severe liver and kidney dysfunction who cannot tolerate surgery; ⑤male children with unsatisfied control of local infection; and ⑥male children who were unable to cooperate to complete the study. A total of 80 male children with penile hypospadias who were hospitalized in our hospital were enrolled and randomly divided into two groups, with 40 cases in each group. Children in the study group underwent microsurgery combined with covering new urethra by multilayer sarcolemma tissues, while those in the control group were provided with traditional urethroplasty. Children in the study group were aged between 4~11 years old (with an average of 7.20 ± 1.92), and those in the control group aged between 4~10 years old (with an average age of 6.90 ± 1.69). There was no significant difference in the comparison of general data between the two groups (p > 0.05), suggesting the comparability between groups ( Table 1 ). Table 1 Comparison of general data in patients between the two groups (x̄ ± S)n = 40 Indexes Study group Control group t/χ 2 p Age (years) 7.20 ± 1.92 6.90 ± 1.69 0.741 0.461 Urethral orifice 1.003 0.317 Distal (%) 31 (77.50%) 27 (67.50%) Central (%) 9 (22.50%) 13 (32.50%) Length of urethral defect (cm) 1.70 ± 0.38 1.65 ± 0.42 0.648 0.519 Width of urethral plate (mm) 9.05 ± 1.51 8.97 ± 1.57 0.225 0.823 Combined with mild chordee of penis 0.287 0.592 With (%) 8 (20.00%) 10 (25.00%) Without (%) 32 (80.00%) 30 (75.00%) p > 0.05 Children in the control group were treated with traditional tubularized incised plate (TIP) urethroplasty. In terms of the specific surgical procedures, under general anesthesia, male children were kept in their supine position and given routine disinfection of perineum and surgical towel laying, suture with 4 − 0 threads to fix the penis head combined with proper traction. After measuring the distance between the urethral orifice and the penis head with a ruler, a U-shaped incision was made under the urethral orifice to bypass around the urethral orifice and extend to the penis head in parallel on both sides. A circumferential incision of the foreskin was further made 0.5cm below the coronary sulcus to Buck fascia to release the skin and subcutaneous fascia, and straighten the penis. After indwelling the urethral catheter, 4 − 0 absorbable thread was used for intermittent evting suture of the marginal flap of the urethral plate without tension. Then, the pedicled sarcolemma flap on the dorsal side of the penis was dissociated to cover the newly constructed urethra, followed by median longitudinal incision of the dorsal foreskin to the ventral side to transfer the flap to wrap the penis. After that, the incision was closed and dressed with sterile gauze. The operation of the study group was performed under the microscope intraoperatively, using 6 − 0 Vicryl for suture. As for the procedure steps, on the basis of the control group, the superficial fascia of the ventral penis in the 4–8 o'clock direction was sharply separated from the proximal part of the penis to the mid-distal part of the penis with a microsurgical scissors until it was about 3mm below the original urethral orifice. Then, the superficial fascia of the penis was turned up 180° to form a tipping bucket-shaped sarcolemma flap, which was then sutured to the urethra covered with sarcolemma on the dorsal side of the penis using 6 − 0 Vicryl to form a multilayer sarcolemma coverage. Outcome measures: ①Surgery-related indicators: Comparative analysis was performed on the operation time, total intraoperative amount of bleeding, postoperative length of stay in the hospital and other indicators between the two groups; ②Surgical effects between two groups of male children were compared and analyzed according to the following criteria for effect evaluation: (1) significant effective: complete disappearance of symptoms and the ability to urinate by standing by the patients themselves; (2) effective: relief of symptoms and the ability to urinate by standing by the patients themselves after treatment, yet with pain and discomfort; and (3) ineffective: no improvement in the symptoms. The total effective rate was calculated based on the formula of (cases of significant effective + effective) / total cases×100%[8]; ③Comparative analysis of postoperative conditions: The urinary fistula, urethral stricture and not satisfied with the appearance were compared and analyzed 3 months after surgery. The HOSE scoring system was employed to score according to the location, shape, urine flow, residual chordee of penis, urinary fistula and its complexity (satisfied: ≥14 points)[9]; and ④Changes of urodynamic indexes: Changes of urodynamic parameters such as maximum urinary flow rate(Qmax), mean urinary flow rate(Qavc), post-void residual urine(PVR) were compared and analyzed before surgery and during the 6-month follow-up period after surgery. Statistical analysis All data were analyzed statistically by SPSS 20.0 software, and the measurement data were expressed by (± S). The data between the study group and the control group were analyzed by two-independent sample t-test. Moreover, paired t-test was used for the comparative analysis of all indicators in the study group before and after treatment, and χ 2 test was used for the comparison of rates. P < 0.05 was used to indicate the presence of statistically significant difference. Results As shown in Table 2, there were statistically significant differences that the operation time(p = 0.03) was longer while the postoperative length of stay in the hospital(p = 0.000) was shorter in the study group than those in the control group. However, there was no statistical difference in the comparison of the amount of intraoperative bleeding between the study group and the control group (p = 0.112). Table 2 Comparison of surgical conditions between the two groups ( x̄ ± S)n = 40 Groups Operation time (min)* Amount of bleeding (ml) Postoperative length of stay (d)* Study group 132.58 ± 8.27 16.45 ± 2.86 9.78 ± 1.23 Control group 120.90 ± 8.13 17.55 ± 3.25 12.45 ± 2.06 t 6.365 1.608 7.046 p 0.000 0.112 0.000 *p < 0.05 According to the comparison of surgical effect between the two groups in Table 3, the effective rate of the study group was 97.50%, while that of the control group was 82.50%. There was statistically significant difference that the effective rate of the former group was obviously higher than that of the latter group (p = 0.025). Table 3 Comparison of surgical effect between the two groups ( x̄ ± S)n = 40 Groups Significant effective Effective Ineffective Total effective rate* Study group 37 2 1 39 (97.50%) Control group 28 5 7 33 (82.50%) χ2 5.000 p 0.025 *p < 0.05 In Table 4, the incidence of surgical complications was 7.50% in the study group and 25.00% in the control group 3 months after operation, with a significantly lower rate in the former group than that in the latter group (p = 0.034). Meanwhile, there was statistically significant difference that the Hose score of the study group was significantly higher than that of the control group (p = 0.000). Table 4 Comparison of the incidence of complications in the two groups of male children 3 months after operation ( x̄ ± S)n = 40 Groups Urinary leakage Urethral stricture Not satisfied with the appearance Incidence of complications* Hose SCORE Study group 0 1 2 3 (7.50%) 16.58 ± 1.72 Control group 4 1 5 10 (25.00%) 14.48 ± 1.91 t/χ 2 4.501 5.166 p 0.034 0.000 *p 0.05). While the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after surgery, with statistically significant difference (p = 0.000). However, no significant difference was found in postoperative level of PVR between the two groups (p = 0.699; Table 5). Table 5 Comparison of urodynamic parameters before and after operation in the two groups of male children ( x̄ ± S)n = 40 Indicators Groups Study group Control group t p Qmax (ml/s) Preoperative 8.97 ± 2.02 9.11 ± 1.94 0.310 0.757 Postoperative 9.86 ± 1.95 8.04 ± 1.81 4.335 0.000 Qavc (ml/s) Preoperative 6.48 ± 2.31 6.39 ± 1.94 0.194 0.847 Postoperative 8.35 ± 2.11 6.08 ± 1.97 4.978 0.000 PVR (ml) Preoperative 12.66 ± 2.61 12.72 ± 2.34. 0.108 0.914 Postoperative 10.47 ± 2.58 10.68 ± 2.24 0389 0.699 *p < 0.05 Discussion Hypospadias is a common congenital malformation of the genitourinary tract in male children, accounting for 0.3%~0.5% of newborn boys, and still has an increased incidence recently [ 10 ]. Among them, distal penile hypospadias accounts for about 70% of all cases of hypospadias [ 11 ]. As a multifactorial disease, hypospadias may occur owing to the impact of heredity factors, environmental factors, hormone regulation, gene mutations, etc. Considering its complex etiology and pathogenesis, the exact cause of hypospadias can be clarified in only less than 5% of male children [ 12 ]. Surgery is still the current gold standard for hypospadias [ 13 ]. The most common complications of surgery for hypospadias are urinary fistula, urethral stricture and unsatisfactory appearance, which brings great psychological pressure to the affected male children and heavy economic burden to their families [ 14 ]. Urinary leakage has been estimated to have the highest incidence among all postoperative complications of surgery for hypospadias. Most male children may need to undergo secondary operation or multiple operations owing to the presence of urinary fistula [ 15 ]. Urinary fistula is generally developed due to the weakness of tissues covering the newly formed urethra or poor blood supply [ 16 ], distal urethral obstruction and postoperative infection. Therefore, the innovation and modification of tissue-covering technology has been highly valued for the improvement of surgery for hypospadias in recent decades[ 17 ]. The tissues to cover the newly established urethra of hypospadias mainly include subcutaneous sarcolemma of penis, tunica vaginalis of testis, Buck's fascia, external spermatic fascia, tunica dartos of the scrotum, etc.[ 18 ]. For example, Daboos et al. [ 19 ] carried out a research based on a random grouping of hypospadias patients into multilayer coverage and no coverage groups. Corresponding results revealed that multilayer coverage could effectively reduce the postoperative complications, especially urinary fistula. It can be considered that coverage of the newly established urethra with multilayer tissue flap can not only reduce the tension of the newly formed urethra, avoid suture overlapping, but also enhance local anti-infection. Meanwhile, by enrolling patients undergoing TIP surgery, Savanelli et al. [ 20 ] randomly established two groups of ventral subcutaneous flap coverage group and no coverage group. Consequently, the incidence of urinary fistula in the coverage group was significantly reduced than that in the no coverage group. In addition, according to the report by Mammo et al.[ 21 ], the effect of sheath coverage for distal hypospadias was worse than that of vascular pedicle coverage, suggesting the application of double-layer vascular pedicle to cover the newly formed urethra. Moreover, Mammo et al. believed that the newly formed urethra of distal hypospadias was far away from the scrotum, and hence the desired effect was difficult to achieve when there was an excessive stretching of the tissue as it could cause poor tissue blood circulation. Therefore, for the initial treatment of distal hypospadias, it is recommended to cover the newly formed urethra with proximal tissues such as penis sarcolemma, rather than distal tissues (e.g., the tunica vaginalis of testis, tunica dartos of the scrotum, etc.). Microscopic technology is generally employed under the microscope. Via this approach, tissues and blood vessels can be magnified in the corresponding multiple under the field of vision to provide a clearer surgical field, which can ensure the accuracy of surgery. The technical concept of microsurgery is proposed to ensure the success of operation, which includes fine operation, protection of blood vessels and nerves, adequate protection of normal tissues, and non-invasive suture[ 22 ]. The key to the success in the surgery for hypospadias is the achievement of tension-free and satisfactory suture of the new urethral lumen. Especially for children with relatively narrow urethral plates, microsurgery has achieved satisfactory anatomical separation of skin flaps, suture of newly formed urethral lumens and coverings under the magnified surgical field by using more sophisticated surgical instruments, thus reducing the occurrence of postoperative complications[ 23 ]. Significantly, microsurgery for hypospadias has obvious advantages. To be specific, it can reduce the side injury of blood vessels and skin tissues as much as possible, and better protect the blood supply of the pedicled urethral plate flap. Moreover, the anatomical layers of tissues can be clearly distinguished during the shaping and dissociation of skin flaps under microscope to avoid postoperative edema of tissues and urethra, ischemia and necrosis of skin flap, etc. In addition, the use of fine sutures and small suture needles under the microscope for precise suture and smooth anastomotic alignment can accelerate wound healing, smooth wound surface and reduce the risk of stenosis of the newly established urethral lumen, which can eventually reduce postoperative complications and accelerate postoperative healing [ 24 ]. Besides, as suggested by ElKaramany et al. [ 25 ], the application of microsurgery can also reduce postoperative pain, short the length of stay in the hospital and dressing change time, and decrease the incidence of postoperative complications for patients with distal hypospadias. Furthermore, urethral stricture, second only to urethral fistula, is also one of the common complications after urethroplasty for hypospadias. According to previous report, the incidence of urethral stricture was 10%~20% after surgery for hypospadias [ 26 ], which occurred usually at the proximal and distal urethral anastomosis and the distal urethral duct 1 ~ 6 months after surgery. Therefore, early identification of urethral stricture and timely treatment are crucial for postoperative recovery and long-term effect of male children [ 27 ]. Measurement of urinary flow rate is simple and non-invasive to detect urethral stricture [ 28 ]. Abnormal urinary flow has been considered to have an inevitable relationship with urethral stricture to some extent [ 29 ]. Abnormal urinary flow is an early warning of the risk of urethral stricture in 50% of cases after surgery for hypospadias. It highlights the necessity of preoperative and postoperative urinary flow measurement. Among them, Qmax is a simple and effective choice to evaluate urethral stricture [ 30 ]. There is a reason to suspect urethral stricture when there is a reduced urinary flow rate. In the present study, the length of stay in the hospital was significantly shorter in the study group than that in the control group (p = 0.000). The effective rate in the study group and the control group was 97.50% and 82.50%, respectively, with statistically significant difference between groups (p = 0.025). Meanwhile, comparison of the incidence of surgical complications showed statistically significant difference between the study group (6%) and the control group (20%) 3 months after operation (p = 0.034). The Hose score in the study group was significantly higher than that in the control group, with a statistically significant difference (p = 0.000). Besides, statistically significant difference was also observed that the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after operation (p = 0.000). Conclusions To sum up, microsurgery combined with covering new urethra by multilayer sarcolemma tissues has some significance in preventing postoperative complications in male children with hypospadias. It exhibits more significant therapeutic effect, which is manifested in the shorter length of hospital stay, lower incidence of postoperative complications, and significantly improved urodynamic indicators. Findings in our study support the potential clinical application value of this approach in the surgical treatment of male children with hypospadias. Our study still has some limitation, such as the experimental design of single-center study that may have certain selection bias. Moreover, our study was performed based on a limited sample size during a shorter period of follow-up. Our study failed to establish a control group of microsurgery combined with covering new urethra by single-layer sarcolemma tissues. In the future, there is a need for multi-center standardized clinical research based on a larger sample size, so as to objectively evaluate the advantages and disadvantages of this surgical strategy. Abbreviations TIP Tubularized Incised Plate PVR Post-Void Residual Declarations Author contributions Z.W, G. SL and S. XQ designed the study; W. J, Z. BS, L. LW and L . C collected and analyzed the data; Y. B wrote the manuscript. All the authors have read and agreed to the published version of the manuscript. Conflict of Interests The authors declare no conflicts of interest. Ethical Approval The study was approved by the Institutional Ethics Committee of Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital. Funding/Support This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data availability None. Informed Consent Written informed consent was obtained from all the children and their parents. Acknowledgements None References Ceccarelli PL, Lucaccioni L, Poluzzi F, Bianchini A, Biondini D, Iughetti L, Predieri B. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr. 2021;21(1):523. doi: 10.1186/s12887-021-02941-4. PMID: 34836527; PMCID: PMC8620229. Joodi M, Amerizadeh F, Hassanian SM, Erfani M, Ghayour-Mobarhan M, Ferns GA, Khazaei M, Avan A. The genetic factors contributing to hypospadias and their clinical utility in its diagnosis. J Cell Physiol. 2019;234(5):5519-5523. doi: 10.1002/jcp.27350. Epub 2018 Sep 21. PMID: 30238986. Gul M, Hildorf S, Silay MS. Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res. 2021;33(2):149-163. doi:10.1038/s41443-020-00377-5. Wood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res. 2023;35(1):61-66. doi: 10.1038/s41443-022-00563-7. Epub 2022 Mar 29. PMID: 35352016. Misra D, Amin AM, Vareli A, Lee L, McIntosh M, Friedmacher F. Urethral fistulae following surgery for scrotal or perineal hypospadias: A 20-year review. J Pediatr Urol. 2020;16(4):447.e1-447.e6. doi: 10.1016/j.jpurol.2020.06.018. Epub 2020 Jun 21. PMID: 32654895. Floratos S, Kim S. Modern Endodontic Microsurgery Concepts: A Clinical Update. Dent Clin North Am. 2017;61(1):81-91. doi: 10.1016/j.cden.2016.08.007. PMID: 27912820. Gupta A, Sunil K, Singh GP, Kureel SN. Study of Variations in Axial Pattern Vessels of Penile Dartos in Hypospadias and Implied Surgical Significance. Urology. 2020;146:201-206. doi: 10.1016/j.urology.2020.08.016. Epub 2020 Aug 21. PMID: 32835743. Krull S, Rissmann A, Krause H, Mohnike K, Roehl FW, Koehn A, Hass HJ. Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score. Eur J Pediatr Surg. 2018;28(3):268-272. doi: 10.1055/s-0037-1602252. Epub 2017 May 15. PMID: 28505692. Bagnara V, Giammusso B, Castagnetti M, Esposito C, Bianchi A. Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol. 2020;16(1):69.e1-69.e5. doi: 10.1016/j.jpurol.2019.10.015. Epub 2019 Oct 23. PMID: 31740147. Malhotra NR, Schaeffer AJ, Slade AD, Cartwright PC, Lau GA. Post-hypospadias urethrocutaneous fistulae: no difference in repair success between proximal and distal fistulae. Can J Urol. 2020;27(6):10466-10470. PMID: 33325350; PMCID: PMC9831685. Honkisz I, Sulisławski J, Dobrowolska-Glazar B, Kuijper CF, Chrzan R. Foreskin healing after distal hypospadias repair: Does stenting affect the outcome? Adv Clin Exp Med. 2020;29(12):1487-1490. doi: 10.17219/acem/127677. PMID: 33389839. Ru W, Tang D, Wu D, Tao C, Chen G, Wei J, Tian H, Shu Q. Identification of risk factors associated with numerous reoperations following primary hypospadias repair. J Pediatr Urol. 2021;17(1):61.e1-61.e5. doi: 10.1016/j.jpurol.2020.11.010. Epub 2020 Nov 12. PMID: 33246830. Mammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci. 2018;28(6):735-740. doi: 10.4314/ejhs.v28i6.8. PMID: 30607090; PMCID: PMC6308759. Cornwell LB, Campbell PC, Ewing E, Swords KA. Children undergoing outpatient complex penile surgery and hypospadias repair may not require opioid analgesics. J Pediatr Surg. 2022;57(4):678-682. doi: 10.1016/j.jpedsurg.2021.05.017. Epub 2021 May 29. PMID: 34162480. Yilmaz Ö, Okçelik S, Soydan H, Ateş F, Yeşildal C, Aktaş Z, Şenkul T. Our urethrocutaneous fistula repair results in adults after hypospadias surgery. Rev Int Androl. 2018;16(4):143-146. doi: 10.1016/j.androl.2017.07.002. Epub 2017 Oct 21. PMID: 30286868. Krull S, Rissmann A, Krause H, Mohnike K, Roehl FW, Koehn A, Hass HJ. Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score. Eur J Pediatr Surg. 2018;28(3):268-272. doi: 10.1055/s-0037-1602252. Epub 2017 May 15. PMID: 28505692. Duarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Tarmono, Utomo T, Yuri P, Siregar S, Wahyudi I, Situmorang GR, Ansharullah Palinrungi MA, Hutasoit YI, Hutahaean AYA, Zulfiqar Y, Sigumonrong YH, Mirza H, Rodjani A, Kloping YP. Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia. J Pediatr Urol. 2020;16(3):317.e1-317.e6. doi: 10.1016/j.jpurol.2020.04.011. Epub 2020 Apr 19. PMID: 32360223. Fahmy O, Khairul A, Mohd GS, Christian S, Tina S, Arnulf Z, Mohamed HG, Georgios. Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review. Eur Urol. 2016; 70(2): 293-298. Daboos M, Helal AA, Salama A. Five years' experience of double faced tubularized preputial flap for penoscrotal hypospadias repair in pediatrics. J Pediatr Urol. 2020;16(5):673.e1-673.e7. doi: 10.1016/j.jpurol.2020.07.037. PMID: 32800482. Savanelli A，Esposito C，Settimi A. A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol. 2007;25 (6): 641-645. doi: 10.1007/s00345-007-0215-2. Mammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci. 2018;28(6):735-740. doi: 10.4314/ejhs.v28i6.8. PMID: 30607090; PMCID: PMC6308759. Izadpanah A, Moran SL. Pediatric Microsurgery: A Global Overview. Clin Plast Surg. 2020;47(4):561-572. doi: 10.1016/j.cps.2020.06.008. PMID: 32892801. Chiummariello S, Arleo S, Rizzo I, Monarca C, Dessy LA, Scuderi N, Alfano C. New head-mounted miniaturized microscope in hypospadia surgical correction. Minerva Chir. 2013;68(2):207-12. PMID: 23612235. Snodgrass W, Bush N. Recurrent ventral curvature after proximal TIP hypospadias repair. J Pediatr Urol. 2021;17(2):222.e1-222.e5. doi: 10.1016/j.jpurol.2020.11.030. Epub 2020 Nov 30. PMID: 33339735. El-Karamany TM, Al-Adl AM, Omar RG, Abdel Aal AM, Eldakhakhny AS, Abdelbaki SA. A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes. Urology. 2017;107:202-208. doi: 10.1016/j.urology.2017.04.056. Epub 2017 Jun 15. PMID: 28625592. Talab SS, Cambareri GM, Hanna MK. Outcome of surgical management of urethral stricture following hypospadias repair. J Pediatr Urol. 2019;15(4):354.e1-354.e6. doi: 10.1016/j.jpurol.2019.05.025. Epub 2019 May 27. PMID: 31262655. Snodgrass WT, Bush NC. Management of Urethral Strictures After Hypospadias Repair. Urol Clin North Am. 2017 Feb;44(1):105-111. doi: 10.1016/j.ucl.2016.08.014. PMID: 27908364. Vega Mata N, Gutiérrez Segura C, Álvarez Muñoz V, Oviedo Gutiérrez M, Montalvo Ávalos C. Revisión uroflujométrica de pacientes intervenidos de hipospadias distales [Uroflowmetric review of pediatric distal urethroplasty]. Cir Pediatr. 2015;28(1):6-9. Spanish. PMID: 27775264. Piplani R, Aggarwal SK, Ratan SK. Role of uroflowmetry before and after hypospadias repair. Urol Ann. 2018;10(1):52-58. doi: 10.4103/UA.UA_78_17. PMID: 29416276; PMCID: PMC5791458. Pan P. Can Grafted Tubularized Incised Plate Urethroplasty be Used to Repair Narrow Urethral Plate Hypospadias? Its Functional Evaluation Using Uroflowmetry. J Indian Assoc Pediatr Surg. 2019;24(4):247-251. doi: 10.4103/jiaps.JIAPS_151_18. PMID: 31571754; PMCID: PMC6752077. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3972667","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274140988,"identity":"95feb203-8f5e-47e5-826c-55e613ecf151","order_by":0,"name":"Wei Zheng","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zheng","suffix":""},{"id":274140989,"identity":"4feae3ee-c177-4a3f-b2c9-926476a075fa","order_by":1,"name":"Shi-lei Guo","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shi-lei","middleName":"","lastName":"Guo","suffix":""},{"id":274140990,"identity":"0a897b48-11d9-4aff-9f48-c87776d56b90","order_by":2,"name":"Xiao-qing Shi","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiao-qing","middleName":"","lastName":"Shi","suffix":""},{"id":274140991,"identity":"a5e449a8-d76a-45f5-a781-7e6a715299bb","order_by":3,"name":"Jie Wang","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Wang","suffix":""},{"id":274140992,"identity":"01aa7c18-7c9c-4f14-a8bc-7b8082c2c1bc","order_by":4,"name":"Bo-song Zhang","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bo-song","middleName":"","lastName":"Zhang","suffix":""},{"id":274140993,"identity":"8ce96466-8bab-4514-9385-49c75ed38772","order_by":5,"name":"Li-wei Li","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li-wei","middleName":"","lastName":"Li","suffix":""},{"id":274140994,"identity":"64cc7674-4099-4f80-a866-7f9570e5eed6","order_by":6,"name":"Chuang Liu","email":"","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chuang","middleName":"","lastName":"Liu","suffix":""},{"id":274140995,"identity":"ef278577-fbe6-4c4c-b25b-20f0fba80139","order_by":7,"name":"Bin Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIie3RMWrDMBiGYQuDsnyu1oqGnkGhYNdg6qsYApp8AI8qhkw+gAKBHqLQWcHUk2nWFC0thU4enK1bG4+F2snYQe8o/gekX57ncv3bCgry8FG/9V8JGFPnkPZi7ispF+tKzrk2Zwiyuk5mKhdXoHUiVDY9Hc3q50e0IQLVZDfADsIzpD/k4ySupLQoJPh9ad43txaRr3y+fhonwuShRdtgUdJMdLCIlaF+MEV2XWiD1TfSBuIS9AXCZCfIPh/IcckVBAc1p0msP+Xrpj0STYclL8H1tpx8S8SWzb4raEq0P3zlXcpYue0PUxf744yo8fkR4nK5XK7f/QABm1WC3PmEWwAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital","correspondingAuthor":true,"prefix":"","firstName":"Bin","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2024-02-20 11:36:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3972667/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3972667/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54712259,"identity":"79f260f3-fe3e-450b-bc48-3f4774a06b94","added_by":"auto","created_at":"2024-04-15 14:58:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":324289,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3972667/v1/f4ff3a7f-33b5-4d34-b6f4-790f9a52eff0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Value of Microsurgery Combined with Covering New Urethra by Multilayer Sarcolemma Tissues in the Treatment of Hypospadias in Male Children and Analysis of Urodynamic Parameters","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypospadias has been recognized to be a common congenital malformation in Pediatric Urology. Children with hypospadias generally show ectopic position of the urethral orifice, chordee of penis and scarf-like changes in the dorsal foreskin of the penis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is a highly heterogeneous multifactorial disease, which may be attributed to multiple genetic and environmental factors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hypospadias is commonly treated by surgery to restore its appearance and function. It can be corrected at any age, without significant difference in the risk of complications, functional recovery and cosmetic effect. However, correction at an earlier stage is recommended by most researchers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. At present, there are many corrective operations for hypospadias, yet accompanied by relatively higher incidence of postoperative complications. The major surgical complications are postoperative urinary fistula, urethral stricture, and unsatisfactory appearance, with the highest rate of urinary fistula in particular [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, great concern in the treatment of hypospadias has been attached to the exploration of appropriate approaches to reduce the surgical complications.\u003c/p\u003e \u003cp\u003eThe construction of abundant tissue barriers between the newly established urethra and the skin is the key to the surgery for hypospadias, which can reduce the occurrence of postoperative urinary fistula and promote the healthy formation of the newly formed urethra [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the continuous development of science and technology, initial success has been realized in the application of microscopy for the repair of hypospadias. Through microscopic operation, the direction of blood vessels can be clearly visualized to ensure good blood supply of the covered tissue, leading to an improved success rate of surgery and hence reduced incidence of postoperative complications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. With respect to the above, this study explored the combination of multilayer sarcolemma tissue to cover the new urethra and microsurgery to improve the surgery for hypospadias, so as to reduce the occurrence of postoperative complications, which are reported as follows:\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eInclusion criteria:①male children who met the diagnostic criteria for penile hypospadias[7];\u0026nbsp;②male children without obvious chordee of penis or with mild chordee of penis that required no surgical correction; ③male children with flat urethral plates that were \u0026ge; 6mm in width and had good elasticity; ④male children with urethral orifice located at the distal end and in the middle of the penis; ⑤male children who aged\u0026nbsp;\u0026le; 12 years old;\u0026nbsp;⑥male children without heart, lung and other important organ diseases and other surgical contraindications;\u0026nbsp;⑦male children with complete clinical data;⑧male children whose family members agreed to accept the study and signed the informed consent form; and\u0026nbsp;⑨male children without obvious symptoms of mental nervous system, with good treatment compliance, and those who could cooperate with the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eExclusion criteria:\u0026nbsp;①male children with chordee of penis requiring surgical correction; ②male children with secondary surgical intervention;\u0026nbsp;③male children with urethral orifice at the junction of penis and scrotum;\u0026nbsp;④male children with severe liver and kidney dysfunction who cannot tolerate surgery;\u0026nbsp;⑤male children with unsatisfied control of local infection; and\u0026nbsp;⑥male children who were unable to cooperate to complete the study.\u003c/p\u003e\n\u003cp\u003eA total of 80 male children with penile hypospadias who were hospitalized in our hospital were enrolled and randomly divided into two groups, with 40 cases in each group. Children in the study group underwent microsurgery combined with covering new urethra by multilayer sarcolemma tissues, while those in the control group were provided with traditional urethroplasty. Children in the study group were aged between 4~11 years old (with an average of 7.20 \u0026plusmn; 1.92), and those in the control group aged between 4~10 years old (with an average age of 6.90 \u0026plusmn; 1.69). There was no significant difference in the comparison of general data between the two groups (p \u0026gt; 0.05), suggesting the comparability between groups (\u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of general data in patients between the two groups (x̄ \u0026plusmn;\u0026thinsp;S)n\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndexes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrethral orifice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDistal (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31 (77.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (67.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCentral (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (22.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (32.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of urethral defect (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidth of urethral plate (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCombined with mild chordee of penis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (20.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (25.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (80.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (75.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eChildren in the control group were treated with traditional tubularized incised plate (TIP) urethroplasty. In terms of the specific surgical procedures, under general anesthesia, male children were kept in their supine position and given routine disinfection of perineum and surgical towel laying, suture with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 threads to fix the penis head combined with proper traction. After measuring the distance between the urethral orifice and the penis head with a ruler, a U-shaped incision was made under the urethral orifice to bypass around the urethral orifice and extend to the penis head in parallel on both sides. A circumferential incision of the foreskin was further made 0.5cm below the coronary sulcus to Buck fascia to release the skin and subcutaneous fascia, and straighten the penis. After indwelling the urethral catheter, 4\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable thread was used for intermittent evting suture of the marginal flap of the urethral plate without tension. Then, the pedicled sarcolemma flap on the dorsal side of the penis was dissociated to cover the newly constructed urethra, followed by median longitudinal incision of the dorsal foreskin to the ventral side to transfer the flap to wrap the penis. After that, the incision was closed and dressed with sterile gauze.\u003c/p\u003e\n\u003cp\u003eThe operation of the study group was performed under the microscope intraoperatively, using 6\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl for suture. As for the procedure steps, on the basis of the control group, the superficial fascia of the ventral penis in the 4\u0026ndash;8 o\u0026apos;clock direction was sharply separated from the proximal part of the penis to the mid-distal part of the penis with a microsurgical scissors until it was about 3mm below the original urethral orifice. Then, the superficial fascia of the penis was turned up 180\u0026deg; to form a tipping bucket-shaped sarcolemma flap, which was then sutured to the urethra covered with sarcolemma on the dorsal side of the penis using 6\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl to form a multilayer sarcolemma coverage.\u003c/p\u003e\n\u003cp\u003eOutcome measures: ①Surgery-related indicators: Comparative analysis was performed on the operation time, total intraoperative amount of bleeding, postoperative length of stay in the hospital and other indicators between the two groups; ②Surgical effects between two groups of male children were compared and analyzed according to the following criteria for effect evaluation: (1) significant effective: complete disappearance of symptoms and the ability to urinate by standing by the patients themselves; (2) effective: relief of symptoms and the ability to urinate by standing by the patients themselves after treatment, yet with pain and discomfort; and (3) ineffective: no improvement in the symptoms. The total effective rate was calculated based on the formula of (cases of significant effective\u0026thinsp;+\u0026thinsp;effective) / total cases\u0026times;100%[8]; ③Comparative analysis of postoperative conditions: The urinary fistula, urethral stricture and not satisfied with the appearance were compared and analyzed 3 months after surgery. The HOSE scoring system was employed to score according to the location, shape, urine flow, residual chordee of penis, urinary fistula and its complexity (satisfied: \u0026ge;14 points)[9]; and ④Changes of urodynamic indexes: Changes of urodynamic parameters such as maximum urinary flow rate(Qmax), mean urinary flow rate(Qavc), post-void residual urine(PVR) were compared and analyzed before surgery and during the 6-month follow-up period after surgery.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e All data were analyzed statistically by SPSS 20.0 software, and the measurement data were expressed by (\u0026plusmn;\u0026thinsp;S). The data between the study group and the control group were analyzed by two-independent sample t-test. Moreover, paired t-test was used for the comparative analysis of all indicators in the study group before and after treatment, and \u0026chi;\u003csup\u003e2\u003c/sup\u003e test was used for the comparison of rates. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used to indicate the presence of statistically significant difference.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs shown in Table 2, there were statistically significant differences that the operation time(p\u0026thinsp;=\u0026thinsp;0.03) was longer while the postoperative length of stay in the hospital(p\u0026thinsp;=\u0026thinsp;0.000) was shorter in the study group than those in the control group. However, there was no statistical difference in the comparison of the amount of intraoperative bleeding between the study group and the control group (p\u0026thinsp;=\u0026thinsp;0.112).\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of surgical conditions between the two groups\u0026nbsp;(\u003cspan style=\"text-align: left;color: rgb(32, 33, 36);background-color: rgb(255, 255, 255);font-size: 20px;\"\u003ex̄\u0026nbsp;\u003c/span\u003e\u0026plusmn;\u0026thinsp;S)n\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOperation time (min)*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAmount of bleeding (ml)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePostoperative length of stay (d)*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132.58\u0026thinsp;\u0026plusmn;\u0026thinsp;8.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120.90\u0026thinsp;\u0026plusmn;\u0026thinsp;8.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003eAccording to the comparison of surgical effect between the two groups in Table 3, the effective rate of the study group was 97.50%, while that of the control group was 82.50%. There was statistically significant difference that the effective rate of the former group was obviously higher than that of the latter group (p\u0026thinsp;=\u0026thinsp;0.025).\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of surgical effect between the two groups\u0026nbsp;(\u003cspan style=\"text-align: left;color: rgb(32, 33, 36);background-color: rgb(255, 255, 255);font-size: 20px;\"\u003ex̄\u0026nbsp;\u003c/span\u003e\u0026plusmn;\u0026thinsp;S)n\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificant effective\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEffective\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIneffective\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal effective rate*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39 (97.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33 (82.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003eIn Table 4, the incidence of surgical complications was 7.50% in the study group and 25.00% in the control group 3 months after operation, with a significantly lower rate in the former group than that in the latter group (p\u0026thinsp;=\u0026thinsp;0.034). Meanwhile, there was statistically significant difference that the Hose score of the study group was significantly higher than that of the control group (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\n\u003cdiv\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of the incidence of complications in the two groups of male children 3 months after operation (\u003cspan style=\"text-align: left;color: rgb(32, 33, 36);background-color: rgb(255, 255, 255);font-size: 20px;\"\u003ex̄\u0026nbsp;\u003c/span\u003e\u0026plusmn;\u0026thinsp;S)n\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUrinary leakage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUrethral stricture\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNot satisfied with the appearance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncidence of complications*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHose SCORE\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3 (7.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10 (25.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.166\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThere was no significant difference in indicators such as Qmax, Qavc and PVR between the two groups before surgery (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). While the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after surgery, with statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.000). However, no significant difference was found in postoperative level of PVR between the two groups (p\u0026thinsp;=\u0026thinsp;0.699; Table 5).\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eComparison of urodynamic parameters before and after operation in the two groups of male children\u0026nbsp;(\u003cspan style=\"text-align: left;color: rgb(32, 33, 36);background-color: rgb(255, 255, 255);font-size: 20px;\"\u003ex̄\u0026nbsp;\u003c/span\u003e\u0026plusmn;\u0026thinsp;S)n\u0026thinsp;=\u0026thinsp;40\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndicators\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroups\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eQmax (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.757\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eQavc (ml/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.847\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePVR (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.66\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eHypospadias is a common congenital malformation of the genitourinary tract in male children, accounting for 0.3%~0.5% of newborn boys, and still has an increased incidence recently [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Among them, distal penile hypospadias accounts for about 70% of all cases of hypospadias [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. As a multifactorial disease, hypospadias may occur owing to the impact of heredity factors, environmental factors, hormone regulation, gene mutations, etc. Considering its complex etiology and pathogenesis, the exact cause of hypospadias can be clarified in only less than 5% of male children [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Surgery is still the current gold standard for hypospadias [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The most common complications of surgery for hypospadias are urinary fistula, urethral stricture and unsatisfactory appearance, which brings great psychological pressure to the affected male children and heavy economic burden to their families [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrinary leakage has been estimated to have the highest incidence among all postoperative complications of surgery for hypospadias. Most male children may need to undergo secondary operation or multiple operations owing to the presence of urinary fistula [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Urinary fistula is generally developed due to the weakness of tissues covering the newly formed urethra or poor blood supply [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], distal urethral obstruction and postoperative infection. Therefore, the innovation and modification of tissue-covering technology has been highly valued for the improvement of surgery for hypospadias in recent decades[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The tissues to cover the newly established urethra of hypospadias mainly include subcutaneous sarcolemma of penis, tunica vaginalis of testis, Buck's fascia, external spermatic fascia, tunica dartos of the scrotum, etc.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. For example, Daboos et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] carried out a research based on a random grouping of hypospadias patients into multilayer coverage and no coverage groups. Corresponding results revealed that multilayer coverage could effectively reduce the postoperative complications, especially urinary fistula. It can be considered that coverage of the newly established urethra with multilayer tissue flap can not only reduce the tension of the newly formed urethra, avoid suture overlapping, but also enhance local anti-infection. Meanwhile, by enrolling patients undergoing TIP surgery, Savanelli et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] randomly established two groups of ventral subcutaneous flap coverage group and no coverage group. Consequently, the incidence of urinary fistula in the coverage group was significantly reduced than that in the no coverage group. In addition, according to the report by Mammo et al.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], the effect of sheath coverage for distal hypospadias was worse than that of vascular pedicle coverage, suggesting the application of double-layer vascular pedicle to cover the newly formed urethra. Moreover, Mammo et al. believed that the newly formed urethra of distal hypospadias was far away from the scrotum, and hence the desired effect was difficult to achieve when there was an excessive stretching of the tissue as it could cause poor tissue blood circulation. Therefore, for the initial treatment of distal hypospadias, it is recommended to cover the newly formed urethra with proximal tissues such as penis sarcolemma, rather than distal tissues (e.g., the tunica vaginalis of testis, tunica dartos of the scrotum, etc.).\u003c/p\u003e \u003cp\u003eMicroscopic technology is generally employed under the microscope. Via this approach, tissues and blood vessels can be magnified in the corresponding multiple under the field of vision to provide a clearer surgical field, which can ensure the accuracy of surgery. The technical concept of microsurgery is proposed to ensure the success of operation, which includes fine operation, protection of blood vessels and nerves, adequate protection of normal tissues, and non-invasive suture[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The key to the success in the surgery for hypospadias is the achievement of tension-free and satisfactory suture of the new urethral lumen. Especially for children with relatively narrow urethral plates, microsurgery has achieved satisfactory anatomical separation of skin flaps, suture of newly formed urethral lumens and coverings under the magnified surgical field by using more sophisticated surgical instruments, thus reducing the occurrence of postoperative complications[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Significantly, microsurgery for hypospadias has obvious advantages. To be specific, it can reduce the side injury of blood vessels and skin tissues as much as possible, and better protect the blood supply of the pedicled urethral plate flap. Moreover, the anatomical layers of tissues can be clearly distinguished during the shaping and dissociation of skin flaps under microscope to avoid postoperative edema of tissues and urethra, ischemia and necrosis of skin flap, etc. In addition, the use of fine sutures and small suture needles under the microscope for precise suture and smooth anastomotic alignment can accelerate wound healing, smooth wound surface and reduce the risk of stenosis of the newly established urethral lumen, which can eventually reduce postoperative complications and accelerate postoperative healing [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Besides, as suggested by ElKaramany et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], the application of microsurgery can also reduce postoperative pain, short the length of stay in the hospital and dressing change time, and decrease the incidence of postoperative complications for patients with distal hypospadias.\u003c/p\u003e \u003cp\u003eFurthermore, urethral stricture, second only to urethral fistula, is also one of the common complications after urethroplasty for hypospadias. According to previous report, the incidence of urethral stricture was 10%~20% after surgery for hypospadias [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], which occurred usually at the proximal and distal urethral anastomosis and the distal urethral duct 1\u0026thinsp;~\u0026thinsp;6 months after surgery. Therefore, early identification of urethral stricture and timely treatment are crucial for postoperative recovery and long-term effect of male children [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Measurement of urinary flow rate is simple and non-invasive to detect urethral stricture [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Abnormal urinary flow has been considered to have an inevitable relationship with urethral stricture to some extent [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Abnormal urinary flow is an early warning of the risk of urethral stricture in 50% of cases after surgery for hypospadias. It highlights the necessity of preoperative and postoperative urinary flow measurement. Among them, Qmax is a simple and effective choice to evaluate urethral stricture [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. There is a reason to suspect urethral stricture when there is a reduced urinary flow rate.\u003c/p\u003e \u003cp\u003eIn the present study, the length of stay in the hospital was significantly shorter in the study group than that in the control group (p\u0026thinsp;=\u0026thinsp;0.000). The effective rate in the study group and the control group was 97.50% and 82.50%, respectively, with statistically significant difference between groups (p\u0026thinsp;=\u0026thinsp;0.025). Meanwhile, comparison of the incidence of surgical complications showed statistically significant difference between the study group (6%) and the control group (20%) 3 months after operation (p\u0026thinsp;=\u0026thinsp;0.034). The Hose score in the study group was significantly higher than that in the control group, with a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.000). Besides, statistically significant difference was also observed that the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after operation (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTo sum up, microsurgery combined with covering new urethra by multilayer sarcolemma tissues has some significance in preventing postoperative complications in male children with hypospadias. It exhibits more significant therapeutic effect, which is manifested in the shorter length of hospital stay, lower incidence of postoperative complications, and significantly improved urodynamic indicators. Findings in our study support the potential clinical application value of this approach in the surgical treatment of male children with hypospadias.\u003c/p\u003e \u003cp\u003eOur study still has some limitation, such as the experimental design of single-center study that may have certain selection bias. Moreover, our study was performed based on a limited sample size during a shorter period of follow-up. Our study failed to establish a control group of microsurgery combined with covering new urethra by single-layer sarcolemma tissues. In the future, there is a need for multi-center standardized clinical research based on a larger sample size, so as to objectively evaluate the advantages and disadvantages of this surgical strategy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTIP \u0026nbsp;Tubularized Incised Plate\u003c/p\u003e\n\u003cp\u003ePVR \u0026nbsp;Post-Void Residual\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZ.W, G. SL and S. XQ designed the study; W. J, Z. BS, L. LW and L . C collected and analyzed the data; Y. B wrote the manuscript. All the authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Institutional Ethics Committee of Beijing Children\u0026apos;s Hospital Affiliated to Capital Medical University Baoding Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all the children and their parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCeccarelli PL, Lucaccioni L, Poluzzi F, Bianchini A, Biondini D, Iughetti L, Predieri B. Hypospadias: clinical approach, surgical technique and long-term outcome. BMC Pediatr. 2021;21(1):523. doi: 10.1186/s12887-021-02941-4. PMID: 34836527; PMCID: PMC8620229.\u003c/li\u003e\n\u003cli\u003eJoodi M, Amerizadeh F, Hassanian SM, Erfani M, Ghayour-Mobarhan M, Ferns GA, Khazaei M, Avan A. The genetic factors contributing to hypospadias and their clinical utility in its diagnosis. J Cell Physiol. 2019;234(5):5519-5523. doi: 10.1002/jcp.27350. Epub 2018 Sep 21. PMID: 30238986.\u003c/li\u003e\n\u003cli\u003eGul M, Hildorf S, Silay MS. Sexual functions and fertility outcomes after hypospadias repair. Int J Impot Res. 2021;33(2):149-163. doi:10.1038/s41443-020-00377-5.\u003c/li\u003e\n\u003cli\u003eWood D, Wilcox D. Hypospadias: lessons learned. An overview of incidence, epidemiology, surgery, research, complications, and outcomes. Int J Impot Res. 2023;35(1):61-66. doi: 10.1038/s41443-022-00563-7. Epub 2022 Mar 29. PMID: 35352016.\u003c/li\u003e\n\u003cli\u003eMisra D, Amin AM, Vareli A, Lee L, McIntosh M, Friedmacher F. Urethral fistulae following surgery for scrotal or perineal hypospadias: A 20-year review. J Pediatr Urol. 2020;16(4):447.e1-447.e6. doi: 10.1016/j.jpurol.2020.06.018. Epub 2020 Jun 21. PMID: 32654895.\u003c/li\u003e\n\u003cli\u003eFloratos S, Kim S. Modern Endodontic Microsurgery Concepts: A Clinical Update. Dent Clin North Am. 2017;61(1):81-91. doi: 10.1016/j.cden.2016.08.007. PMID: 27912820.\u003c/li\u003e\n\u003cli\u003eGupta A, Sunil K, Singh GP, Kureel SN. Study of Variations in Axial Pattern Vessels of Penile Dartos in Hypospadias and Implied Surgical Significance. Urology. 2020;146:201-206. doi: 10.1016/j.urology.2020.08.016. Epub 2020 Aug 21. PMID: 32835743.\u003c/li\u003e\n\u003cli\u003eKrull S, Rissmann A, Krause H, Mohnike K, Roehl FW, Koehn A, Hass HJ. Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score. Eur J Pediatr Surg. 2018;28(3):268-272. doi: 10.1055/s-0037-1602252. Epub 2017 May 15. PMID: 28505692.\u003c/li\u003e\n\u003cli\u003eBagnara V, Giammusso B, Castagnetti M, Esposito C, Bianchi A. Distal hypospadias repair using the needle point bipolar cutting-coagulation forceps. J Pediatr Urol. 2020;16(1):69.e1-69.e5. doi: 10.1016/j.jpurol.2019.10.015. Epub 2019 Oct 23. PMID: 31740147.\u003c/li\u003e\n\u003cli\u003eMalhotra NR, Schaeffer AJ, Slade AD, Cartwright PC, Lau GA. Post-hypospadias urethrocutaneous fistulae: no difference in repair success between proximal and distal fistulae. Can J Urol. 2020;27(6):10466-10470. PMID: 33325350; PMCID: PMC9831685.\u003c/li\u003e\n\u003cli\u003eHonkisz I, Sulisławski J, Dobrowolska-Glazar B, Kuijper CF, Chrzan R. Foreskin healing after distal hypospadias repair: Does stenting affect the outcome? Adv Clin Exp Med. 2020;29(12):1487-1490. doi: 10.17219/acem/127677. PMID: 33389839.\u003c/li\u003e\n\u003cli\u003eRu W, Tang D, Wu D, Tao C, Chen G, Wei J, Tian H, Shu Q. Identification of risk factors associated with numerous reoperations following primary hypospadias repair. J Pediatr Urol. 2021;17(1):61.e1-61.e5. doi: 10.1016/j.jpurol.2020.11.010. Epub 2020 Nov 12. PMID: 33246830.\u003c/li\u003e\n\u003cli\u003eMammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci. 2018;28(6):735-740. doi: 10.4314/ejhs.v28i6.8. PMID: 30607090; PMCID: PMC6308759.\u003c/li\u003e\n\u003cli\u003eCornwell LB, Campbell PC, Ewing E, Swords KA. Children undergoing outpatient complex penile surgery and hypospadias repair may not require opioid analgesics. J Pediatr Surg. 2022;57(4):678-682. doi: 10.1016/j.jpedsurg.2021.05.017. Epub 2021 May 29. PMID: 34162480.\u003c/li\u003e\n\u003cli\u003eYilmaz \u0026Ouml;, Ok\u0026ccedil;elik S, Soydan H, Ateş F, Yeşildal C, Aktaş Z, Şenkul T. Our urethrocutaneous fistula repair results in adults after hypospadias surgery. Rev Int Androl. 2018;16(4):143-146. doi: 10.1016/j.androl.2017.07.002. Epub 2017 Oct 21. PMID: 30286868.\u003c/li\u003e\n\u003cli\u003eKrull S, Rissmann A, Krause H, Mohnike K, Roehl FW, Koehn A, Hass HJ. Outcome after Hypospadias Repair: Evaluation Using the Hypospadias Objective Penile Evaluation Score. Eur J Pediatr Surg. 2018;28(3):268-272. doi: 10.1055/s-0037-1602252. Epub 2017 May 15. PMID: 28505692.\u003c/li\u003e\n\u003cli\u003eDuarsa GWK, Tirtayasa PMW, Daryanto B, Nurhadi P, Renaldo J, Tarmono, Utomo T, Yuri P, Siregar S, Wahyudi I, Situmorang GR, Ansharullah Palinrungi MA, Hutasoit YI, Hutahaean AYA, Zulfiqar Y, Sigumonrong YH, Mirza H, Rodjani A, Kloping YP. Risk factors for urethrocutaneous fistula following hypospadias repair surgery in Indonesia. J Pediatr Urol. 2020;16(3):317.e1-317.e6. doi: 10.1016/j.jpurol.2020.04.011. Epub 2020 Apr 19. PMID: 32360223.\u003c/li\u003e\n\u003cli\u003eFahmy O, Khairul A, Mohd GS, Christian S, Tina S, Arnulf Z, Mohamed HG, Georgios. Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review. Eur Urol. 2016; 70(2): 293-298.\u003c/li\u003e\n\u003cli\u003eDaboos M, Helal AA, Salama A. Five years\u0026apos; experience of double faced tubularized preputial flap for penoscrotal hypospadias repair in pediatrics. J Pediatr Urol. 2020;16(5):673.e1-673.e7. doi: 10.1016/j.jpurol.2020.07.037. PMID: 32800482.\u003c/li\u003e\n\u003cli\u003eSavanelli A，Esposito C，Settimi A. A prospective randomized comparative study on the use of ventral subcutaneous flap to prevent fistulas in the Snodgrass repair for distal hypospadias. World J Urol. 2007;25 (6): 641-645. doi: 10.1007/s00345-007-0215-2.\u003c/li\u003e\n\u003cli\u003eMammo TN, Negash SA, Negussie T, Getachew H, Dejene B, Tadesse A, Derbew M. Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop J Health Sci. 2018;28(6):735-740. doi: 10.4314/ejhs.v28i6.8. PMID: 30607090; PMCID: PMC6308759.\u003c/li\u003e\n\u003cli\u003eIzadpanah A, Moran SL. Pediatric Microsurgery: A Global Overview. Clin Plast Surg. 2020;47(4):561-572. doi: 10.1016/j.cps.2020.06.008. PMID: 32892801.\u003c/li\u003e\n\u003cli\u003eChiummariello S, Arleo S, Rizzo I, Monarca C, Dessy LA, Scuderi N, Alfano C. New head-mounted miniaturized microscope in hypospadia surgical correction. Minerva Chir. 2013;68(2):207-12. PMID: 23612235.\u003c/li\u003e\n\u003cli\u003eSnodgrass W, Bush N. Recurrent ventral curvature after proximal TIP hypospadias repair. J Pediatr Urol. 2021;17(2):222.e1-222.e5. doi: 10.1016/j.jpurol.2020.11.030. Epub 2020 Nov 30. PMID: 33339735.\u003c/li\u003e\n\u003cli\u003eEl-Karamany TM, Al-Adl AM, Omar RG, Abdel Aal AM, Eldakhakhny AS, Abdelbaki SA. A Critical Analysis of Stented and Unstented Tubularized Incised Plate Urethroplasty Through a Prospective Randomized Study and Assessment of Factors Influencing the Functional and Cosmetic Outcomes. Urology. 2017;107:202-208. doi: 10.1016/j.urology.2017.04.056. Epub 2017 Jun 15. PMID: 28625592.\u003c/li\u003e\n\u003cli\u003eTalab SS, Cambareri GM, Hanna MK. Outcome of surgical management of urethral stricture following hypospadias repair. J Pediatr Urol. 2019;15(4):354.e1-354.e6. doi: 10.1016/j.jpurol.2019.05.025. Epub 2019 May 27. PMID: 31262655.\u003c/li\u003e\n\u003cli\u003eSnodgrass WT, Bush NC. Management of Urethral Strictures After Hypospadias Repair. Urol Clin North Am. 2017 Feb;44(1):105-111. doi: 10.1016/j.ucl.2016.08.014. PMID: 27908364.\u003c/li\u003e\n\u003cli\u003eVega Mata N, Guti\u0026eacute;rrez Segura C, \u0026Aacute;lvarez Mu\u0026ntilde;oz V, Oviedo Guti\u0026eacute;rrez M, Montalvo \u0026Aacute;valos C. Revisi\u0026oacute;n uroflujom\u0026eacute;trica de pacientes intervenidos de hipospadias distales [Uroflowmetric review of pediatric distal urethroplasty]. Cir Pediatr. 2015;28(1):6-9. Spanish. PMID: 27775264.\u003c/li\u003e\n\u003cli\u003ePiplani R, Aggarwal SK, Ratan SK. Role of uroflowmetry before and after hypospadias repair. Urol Ann. 2018;10(1):52-58. doi: 10.4103/UA.UA_78_17. PMID: 29416276; PMCID: PMC5791458.\u003c/li\u003e\n\u003cli\u003ePan P. Can Grafted Tubularized Incised Plate Urethroplasty be Used to Repair Narrow Urethral Plate Hypospadias? Its Functional Evaluation Using Uroflowmetry. J Indian Assoc Pediatr Surg. 2019;24(4):247-251. doi: 10.4103/jiaps.JIAPS_151_18. PMID: 31571754; PMCID: PMC6752077.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Covering by multilayer sarcolemma tissues, Children, Hypospadias, Microsurgery, Clinical effect","lastPublishedDoi":"10.21203/rs.3.rs-3972667/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3972667/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo compare and analyze differences in the clinical effect and postoperative urodynamic indexes of microsurgery combined with covering new urethra by multilayer sarcolemma tissues and conventional surgery alone in the treatment of male children with hypospadias.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 80 male children with penile hypospadias who were hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University Baoding Hospital were randomly divided into two groups, with 40 in each group. Children in the study group underwent microsurgery combined with covering new urethra by multilayer sarcolemma tissues, while those in the control group were provided with traditional tubularized incised plate (TIP) urethroplasty alone. Further comparative analysis was performed on the operation effect, operation time, total intraoperative bleeding, postoperative length of stay in the hospital and the incidence of surgical complications between the two groups. All male children were followed up for 6 months to compare and analyze the changes of urodynamic parameters such as maximum urinary flow rate (Qmax), mean urinary flow rate (Qavc), post-void residual urine (PVR) before and after surgery.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were statistically significant differences that the operation time(p\u0026thinsp;=\u0026thinsp;0.03) was longer while the postoperative length of stay in the hospital (p\u0026thinsp;=\u0026thinsp;0.000) was shorter in the study group than those in the control group. The effective rate of the study group was 97.50%, while that of the control group was 82.50%, with statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.025). The incidence of surgical complications was 7.50% in the study group and 25.00% in the control group 3 months after operation (p\u0026thinsp;=\u0026thinsp;0.034). There was statistically significant difference that the Hose score of the study group was significantly higher than that of the control group (p\u0026thinsp;=\u0026thinsp;0.000). Meanwhile, there was no significant difference in indicators such as Qmax, Qavc and PVR between the two groups before surgery; while the levels of Qmax and Qavc in the study group were higher than those in the control group 6 months after surgery, with statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMicrosurgery combined with covering new urethra by multilayer sarcolemma tissues has certain clinical value in the treatment of male children with hypospadias, which shows good therapeutic effect, shorter length of stay in the hospital, lower incidence of postoperative complications, and significantly improved urodynamic indicators, despite slightly complicated operation and relatively longer duration of operation.\u003c/p\u003e","manuscriptTitle":"Clinical Value of Microsurgery Combined with Covering New Urethra by Multilayer Sarcolemma Tissues in the Treatment of Hypospadias in Male Children and Analysis of Urodynamic Parameters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-22 14:00:55","doi":"10.21203/rs.3.rs-3972667/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"537c2817-3964-469d-9253-67a7f9826807","owner":[],"postedDate":"February 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-09T13:52:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-22 14:00:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3972667","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3972667","identity":"rs-3972667","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}