Objective To investigate the effect of urethral plate reconstruction and tubular urethroplasty(a modified Koyanagi procedure)on voiding function and pain factors in children with hypospadias.Methods A total of 80 children with hypospadias who were treated at Hangzhou Children's Hospital between January 2019 and December 2020 were included in this study.These children were divided into a study group and a control group,with 40 children in each group.The study group underwent modified Koyanagi surgery,while the control group received traditional urethral orifice basal vessel flap urethroplasty.The operative indicators and complications of hypospadias were compared between the two groups.Changes in pain factor levels were analyzed before and 3 days after surgery.Therapeutic effects and changes in voiding function were evaluated 12 months after surgery.Results The intraoperative blood loss in the study group[(24.53±7.84)mL]was significantly less than that in the control group[(43.12±14.35)mL),while the postoperative length of hospital stay[(6.52±1.03)days,t=7.19,P＜0.05]in the study group was significantly shorter than that in the control group[(7.84±1.26)days,t=5.13,P＜0.05].The surgical time in the study group[(132.42±16.56)minutes]was significantly longer than that in the control group[(114.35±17.48)minutes,t=4.74,P＜0.05).The incidence of complications in the study group[7.50％(3/40)]was significantly lower than that in the control group[22.50％(10/40),x2=5.54,P=0.019].At 3 days after surgery,the serum levels of substance P[(147.92±18.98)μg/L],neuropeptide Y[(74.34±5.65)mg/L],and prostaglandin E2[(138.28±21.45)ng/L]in the study group were significantly lower than those in the control group[(189.47±21.25)μg/L,(93.51±6.58)mg/L,(179.95±24.34)ng/L,t=9.22,13.97,8.10,all P＜0.05].At 12 months after surgery,the cure rate in the study group was significantly higher than that in the control group[90.00％(36/40)vs.70.00％(28/40),x2=5.00,P=0.025].At 12 months after surgery,the study group had a higher postoperative urine output[(140.92±12.84)mL]than the control group[(133.27±10.32)mL],with a higher average urine flow rate[(8.54±0.38)mL/s]and a higher maximum urine flow rate[(12.76±1.32)mL/s]than the control group[(7.95±0.47)mL/s,(11.54±1.28)mL/s].All differences were statistically significant(t=2.93,6.17,4.19,all P＜0.05).Conclusion The modifiied Koyanagi procedure has a significant therapeutic effect on hypospadias in children and can significantly improve their voiding function and inhibit the release of pain factors.
HypospadiasReconstructive surgical proceduresIntraoperative complicationsOperative timeLength of stayPain
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