This multicenter study aimed to establish a quantitative, individualized surgical decision algorithm for pediatric hypospadias by analyzing multicenter penile anatomical data, surgical approaches, and follow-up outcomes. To achieve this purpose, clinical data from 1500 primary hypospadias cases across 17 tertiary centers in China (December 2018 to September 2021) were retrospectively reviewed, with patients stratified into urethral plate preservation group (n = 715) and transection group (n = 785). Using multivariate logistic regression, key predictors for intraoperative urethral plate transection were identified, and morphometric parameters were analyzed to guide surgical selection. This analysis led to the development of a predictive nomogram and risk stratification thresholds, which were subsequently validated. The results demonstrated that significant predictors of transection included glans length (odds ratio [OR]: 1.17, 95% confidence interval [CI]: 1.07–1.29), glans width (OR: 0.35, 95% CI: 0.29–0.43), and penile curvature (OR: 1.07, 95% CI: 1.06–1.08), with the nomogram showing excellent discrimination (area under the receiver operating characteristic curve [AUC]: 0.914 in training and 0.87 in validation). Furthermore, for urethral plate preservation, a urethral plate width threshold of 4.25 mm differentiated optimal candidates for tubularized incised plate urethroplasty (width ≥4.25 mm) versus onlay island flap (width <4.25 mm). Notably, in transected cases, a urethral defect length of >3.55 cm was associated with higher complication rates in single-stage repairs (45.8% vs 33.4%, P < 0.05), favoring staged approaches. This algorithm integrates preoperative morphometrics and intraoperative measurements to provide objective, quantifiable guidance for individualized surgical planning, particularly benefiting less experienced surgeons.

This multicenter study aimed to identify risk factors for postoperative complications following tubularized incised plate urethroplasty (TIP) in hypospadias patients and develop a clinical prediction model. Retrospective data from 17 tertiary centers (2018–2021) were analyzed. Inclusion criteria: primary TIP surgery with complete anatomical and follow-up data. Exclusion criteria: prior urethral surgery, genetic disorders, or incomplete records. Multivariate logistic regression identified independent predictors. A nomogram model was constructed and internally validated using bootstrapping (1000 resamples). Discrimination (AUC) and calibration (Hosmer–Lemeshow test) were assessed. Among 493 patients (median follow-up: 42 months), the complication rate was 23.7

To discuss whether decreasing the pressure of endotracheal tube cuff slowly with a constant speed can decrease the incidence of coughing during extubation. Ninety patients undergoing elective noncardiac surgery under general anesthesia with endotracheal intubation were randomly divided into two groups: group P, the pilot balloon was connected to a syringe and an aneroid manometer through a three-way stopcock, respectively, and the decrease of cuff pressure was controlled at 3 cmH2O/s during deflating before extubation; group C, the pressure in endotracheal tube cuff was decreased suddenly with a syringe extracting the air from the cuff rapidly at once exactly before extubation. The incidence of coughing during extubation period was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded before general anesthesia induction (T0), just before cuff deflation (T1), immediately after deflation (T2), at 1 min (T3), 3 min (T4), and 5 min after extubation (T5). The occurrence of adverse reactions was also recorded. The initiation of coughing during extubation period occurs at immediately the time of balloon deflation. Compared with group C, the incidence of coughing was significantly decreased (P = 0.001), MAP and HR were significantly decreased at T2-T4 and T2-T5, respectively (P < 0.05 for all), and the incidence of pharyngolaryngeal discomfort after extubation was significantly reduced (P = 0.021) in group P. Decreasing the pressure of endotracheal tube cuff slowly with a constant speed can significantly reduce the incidence of coughing during extubating period, stabilize hemodynamics, and reduce the incidence of adverse reactions.

BACKGROUND:The aim of this paper was to explore pupillary monitoring for determining remifentanil consumption during general anesthesia and evaluating postoperative recovery quality.METHODS:Eighty patients undergoing elective laparoscopic uterine surgery were randomly divided into pupillary monitoring group (Group P) and control group (Group C). In Group P, remifentanil dosage during general anesthesia was determined according to pupil dilation reflex; in Group C, it was adjusted according to hemodynamic changes. Intraoperative remifentanil consumption and endotracheal tube extraction time were recorded. The Numerical Rating Scale (NRS) Score, hemodynamic changes, and opioid-related adverse reactions in the post-anesthesia care unit were also recorded. The parameters of pupil light reflex from extubation to 30 min after extubation were analyzed in Group P, and the responsiveness of these parameters and hemodynamic changes to NRS was determined by ROC curve analyses.RESULTS:Compared with Group C, in Group P, intraoperative remifentanil consumption, the NRS Score at 20 minutes after extubation, extubation time, and the incidence of nausea, vomiting, and respiratory amnesia were all significantly decreased (all, P<0.05). In Group P, ∆HR and ∆MAP had no value in judging the change of NRS. The ROC values and diagnostic cutoff values of ΔInit, ΔACV, and ΔMCV responding to NRS variation were 0.775 (95% CI: 0.582-0.968), 0.734(95% CI: 0.537-0.930), and 0.822 (95% CI: 0.648-0.997) and 0.21 (sensitivity, 92.3%; specificity, 23.1%), -1.3 (sensitivity, 92.3%; specificity, 18.3%), and -1.0 (sensitivity, 84.6%; specificity, 17.7%), respectively.CONCLUSIONS:Intraoperative pupil dilation reflex monitoring can reduce remifentanil consumption and improve postoperative recovery quality. Furthermore, postoperative pupil light reflex monitoring can help evaluate pain degree with high sensitivity.

Background Hypospadias is a common congenital malformation in pediatric urology with surgery being the only curative treatment. Although there are hundreds of surgical methods for hypospadias, no single method can treat all types, and there are still high rates of postoperative complications. We performed this study to investigate surgical procedure selection and perform risk factor analysis of postoperative complications in hypospadias repair. Methods Retrospective analysis was performed of complete clinical and follow-up data of children with hypospadias who were treated and followed up at 15 children’s clinical centers in Mainland China from December 2018 to December 2019. Children were divided into groups according to Barcat classification and surgical methods in order to analyze the surgical choice for different types of hypospadias and the influencing factors of different surgical methods for complications. Results In total, 1011 patients were followed up for 26 months. According to Barcat classification, there were 248 cases of distal type hypospadias, 214 of intermediate, and 549 of proximal type. Transverse preputial island flap urethroplasty (Duckett) and tubularized incised plate urethroplasty (TIP) were performed in 375 (37.1%) and 336 cases (33.2%), respectively. The postoperative complication rate of distal hypospadias was 23.4% (15.8–57.1%), mid shaft 29.0% (22.7–40.0%), and proximal 43.7% (30.2–52.9%). Among the 375 patients in Duckett group, 192 had complications. Multivariate logistic analysis showed that the length of prepuce island flap ( OR = 3.506, 95% CI : 2.258 – 5.442) was an independent risk factor for complications after Duckett operation ( P < 0.001). In TIP group, there were 336 cases with 84 complications. Multivariate logistic analysis showed that the width of urethral plate after longitudinal resection ( OR = 0.836, 95% CI : 0.742 – 0.942) and glans width ( OR = 0.851, 95% CI : 0.749 – 0.965) were independent risk factors for postoperative complications after TIP ( P = 0.003, P = 0.012). Conclusion Several anatomical features play a role during the selection process among the different surgical approaches, including glans size, urethral plate width, and the meatal position. The width of the urethral plate and glans width were risk factors for postoperative complications after TIP. The length of prepuce island flap was a risk factor for complications after Duckett operation.

Background Proximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee. Methods We retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars’ two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence. Results A total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars’ two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months (P > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (P < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (P > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (P > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (P < 0.05). Conclusions Staged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.

OBJECTIVE:To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery. METHODS:From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared. RESULTS:At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (P>0.05);there was no significant difference in YT20 score before operation (P>0.05), and YT20 score in patients with heterotopic ossification was significantly lower than that in patients without heterotopic ossification(P<0.05). CONCLUSION:The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Objective To evaluate the therapeutic safety and feasibility of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome (SMAS) in children and summarized the methods of diagnosis , surgical treatments and outcomes .Methods A retrospective analysis was conducted for 22 SMAS children undergoing total laparoscopy from April 2016 to December 2018 . There were 13 boys and 9 girls with a mean age of 135 months .The clinical manifestations included abdominal pain (n=22) ,nausea (n= 22) and vomiting (n= 7) .Upper gastrointestinal angiography (n=22) and CT angiography and color Doppler ultrasonography (n = 21 ) were performed for measuring the angle and distance between superior mesenteric artery and abdominal aorta .Results All of them were definitely diagnosed by upper gastrointestinal angiography .CT angiography and Doppler ultrasonography examination could only make a definite diagnosis in 18 and 17 cases .No significant difference existed in diagnostic rate among upper gastrointestinal angiography ,color Doppler ultrasonography and CT (P< 0 .05) .Gastroscopy revealed chronic gastritis and concurrent duodentis (n=6) .All cases underwent successful laparoscopic duodenojejunostomy and side-to-side anastomosis . The average postoperative recovery time of gastrointestinal function was 2(1-3) days ,intraoperative blood loss 5-20 ml ,feeding resumed partially at 4 days and discharge occurred at 7 days .All cases were available at the final follow-up .During an average follow-up period of 11(2-28) months ,20 cases were cured or alleviated with an effective rate of 90 .9％ .There was only 1 case of anastomotic stenosis .Among two cases of poor efficacy ,one case of anastomotic stenosis improved after balloon dilation while another was probably related with bile reflux .Conclusions SMAS is prone to clinical misdiagnosis .Upper gastrointestinal angiography ,CT angiography and color Doppler ultrasonography are essential for making a definite diagnosis .Laparoscopic duodenojejunostomy is both safe and reliable for SM ACS and it is thus worthy of wider popularization .

Objective To explore the experience of the diagnosis and treatment of surgical procedures for hypospadias.Methods Different surgical methods of 220 patients with hypospadias were followed up and analyzed from July 2012 to July 2015.Results Twenty-three patients received MAGPI,78 patients received TIP,85 patients received Duckett,34 patients received Duckett +onla.Postoperative complications included urethral fistula in 18 cases(8.2％),urethral diverticula in 7 cases(3.2％),urethral stricture in 8 cases(3.6％),the head of penis cracked in 9 cases(4.1％).Conclusions Surgery methods should be determined according to the type of hypospadia,reasonable surgical procedure could induce the incidence of surgical complications.

Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.

To evaluate the effect of modified penoplasty in the management of concealed penis.

Purpose: We compare the effects of staged tranverse preputial island flap urethroplasty and the Byars 2-stage procedure in patients with proximal hypospadias and severe chordee. Materials and Methods: We studied 87 consecutive children referred for proximal hypospadias with severe chordee between March 2011 and March 2014. Of the cases 42 were repaired with staged tranverse preputial island flap (group 1) and 45 were managed by 2-stage Byars urethroplasty (group 2). Mean +/- SD age at first stage surgery was 26.6 +/- 13.3 months in group 1 and 24.8 +/- 14.7 months in group 2. Postoperative complications in both groups were assessed regarding fistulas, urethral strictures, diverticula, meatal stenosis and glanular dehiscence. Results: After the second stage 2 patients (4.8%) in group 1 and 10 (23.2%) in group 2 had urethrocutaneous fistulas (p < 0.05). One patient (2.4%) in group 1 and 2 patients (4.4%) in group 2 had urethral strictures (p > 0.05). All patients with stricture were cured by repeated dilation and no patient required re-operation. One patient (2.4%) in group 1 and no patient in group 2 had diverticulum (p > 0.05). No patient in either group had signs or symptoms of meatal stenosis or residual chordee. Three patients (7.1%) in group 1 and 12 (26.7%) in group 2 needed reoperation (p < 0.05). Conclusions: Two-stage urethroplasty, particularly tranverse preputial island flap partial urethroplasty, is appropriate for treating patients with proximal hypospadias and severe chordee. Use of the tranverse preputial island flap can decrease complications associated with the second stage and significantly improve the success rate.

We sought to evaluate the effects of oral testosterone undecanoate treatment based on the temporary growth of penis and the complications of surgery in children with microphallic hypospadias.

Objective To explore the clinical data of the pediatric malignant solid tumor and to summarize the experiences of the pediatric malignant solid tumor treatment in Guangxi.Methods The clinical data of 323 cases of pediatric malinant solid tumor,treated surgically in the First Affiliated Hospital of Guangxi Medical University from Dec.1988 to Dec.2008.Pathology,sex,age,clinical characteristics,diagnosis and treatment were analysed respectively.Results The most frequent histological types were malignant lymphoma,Wilms tumor,neuroblastoma and malignant germ cell tumor.There was a male prevalence with a sex-ratio of 1.99 ∶ 1.The peak incidence in embryo tumor was under 3 years,and epithelium cancer was between the ages of 10-13 years.The main symptoms were palpable mass (56.3) and a few were found in health examination ;64.2％ of the pediatric malignant solid tumor was of stage Ⅲ or Ⅳ ;the complete tumor resection rate was 78.4％.Conclusions The characteristics of pediatric malignant solid tumor is different from those of adults.To detect as soon as possible and treat the pediatric malignant tumor as soon as possible depends on screening.Combined modality therapy can improve the patients complete resection rate and survival quality of the patients.

Objective To summarize our experience on Kasai procedure (KP) for the treatment of biliary atresia (BA).Methods From January 2007 to December 2011,126 patients with type ⅢBA underwent KP at this center.After surgery,112 (89.7％) of them was followed up,and their clinical data were retrospectively analyzed to evaluate the outcome.Results The jaundice free was seen in 70 (62.5％) patients.According to the age at surgery,the patients were divided into 4 groups:≤60 d group,60～90 d group,90～120 d group,and ＞120 d group.The jaundice free rates of the 4 groups were statistically different (jaundice free rate 72.0％,80.5％,60.0％,and 19.0％,respectively,P＜0.05).The incidence of cholangitis was 30.4％ (34/112).The incidence of cholangitis in jaundice free patients was significantly lower than that of the patients with persistent jaundice (21.4％versus 45.2％,P＜0.05).The patients with the age at surgery ＞90 d (93.5％),or persistent jaundice (100％),or postoperative cholangitis (50％),had a higher incidence of hepatic fibrosis.The 1-year and 2-year survival rate with native liver was 64.9％ and 61.8％ respectively.Age at surgery,jaundice,severity of cholangitis and persistent hepatic fibrosis,were the predictive factors for outcomes of surgery (P＜0.05).Conclusions The type Ⅲ BA patients who are younger than 90 days at surgery,jaundice free and less incidence cholangitis after surgery have longer survival time with native liver.

Objective To explore the role of Santulli procedure enterostomy in treatment of high unformed small bowel fistula in children.Methods From May 2007 to Oct.2011,6 cases suffered with high unformed small bowel fistula were treated with Santulli procedure enterostomy.Five male and 1 female were involved and their ages were ranged from 15 days to 5 years.Results The mean time from final diagnosis of intestinal fistula to the definite operation was (52.33 ± 19.03) h,the distance between fistula to the ligament of Treize was (17.33 ± 4.68)cm,the output of enterostomy was (760.00 ± 107.56) mL/d.In the surgical explore,6 cases suffered intestinal adhesions but none of the cases could be separated,5 cases suffered severe and 1 case with moderate intra-abdominal pollution.The preoperative complications included 6 cases with incision infection,1 case with a fully dehiscence of incision,6 cases with generalized peritonitis,2 cases with impaired renal function,1 case with liver dysfunction,3 cases with systemic inflammatory reaction syndrome and sepsis respectively,1 case of incision infection appeared in post-operation.The pediatric critical illness scores and serum albumin of postoperative 3 days and 7 days were higher than those of preoperative (all P ＜0.05).None of the cases suffered the anastomotic leak.The nutrition and growth were normal during the follow-up period of 8 months to 2 years.Conclusions Santulli procedure enterostomy is suitable in treatment of high unformed small bowel fistula in children,and the early performance will improve prognosis.