Modified vs traditional Byars staged urethroplasty in pediatric patients with severe hypospadias: a cohort study

doi:10.3877/cma.j.issn.1674-3253.2025.04.006

Abstract

Abstract:

Objective

To compare the clinical efficacy of modified Byars staged urethroplasty versus traditional procedure in pediatric patients with severe hypospadias.

Methods

A retrospective analysis was conducted on clinical data of 82 pediatric patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2023. Patients were divided into traditional group (31 cases, underwent traditional Byars procedure) and modified group (51 cases, underwent modified Byars procedure) according to surgical approaches. Based on the traditional procedure, the modified Byars technique added glansplasty in stage I and employed Y-shaped flap combined with glans tunnel technique for urethroplasty in stage II. Perioperative indicators, postoperative complication rates, and follow-up outcomes were compared between the two groups.

Results

There were no significant differences between the two groups in preoperative baseline characteristics, operative time, blood loss, and incidence of postoperative complications including urethrocutaneous fistula, urethral stricture, urethral diverticulum, and penile curvature (P>0.05). The incidence of coronal fistula and glanular dehiscence in the modified group were both 0%, significantly lower than 12.90% in the traditional group (P=0.008). The rate of orthotopic urethral orifice in the modified group was 100%, significantly higher than 83.9% in the traditional group (P=0.003). The Hypospadias Objective Penile Evaluation (HOPE) score for penile appearance satisfaction in the modified group was (8.75±0.15), significantly higher than (7.94±0.30) in the traditional group (P=0.010). The modified group achieved normal urethral orifice position with natural slit-like configuration and near-normal penile appearance.

Conclusion

Compared with traditional Byars staged procedure, the modified technique significantly reduces the risk of coronal fistula and glanular dehiscence, improves the rate of orthotopic urethral orifice and penile appearance satisfaction, representing an effective surgical approach for treating severe hypospadias in pediatric patients.

Key words: Hypospadias, Byars staged procedure, Urethroplasty, Cohort study, Pediatric patients

Qigen Xie, Cheng Su, Zhe Xu, Zuoqing Li. Modified vs traditional Byars staged urethroplasty in pediatric patients with severe hypospadias: a cohort study[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(04): 429-435.

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References 32

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组别	例数	年龄[月，(±s)]	尿道开口[例(%)]			阴茎下曲[例(%)]
组别	例数	年龄[月，(±s)]	阴茎阴囊交界	阴囊	会阴	中度	重度
传统组	31	23.3±1.9	15 (48.39)	11 (35.48)	5 (16.13)	13 (41.94)	18 (58.06)
改良组	51	23.8±1.8	23 (45.10)	19 (37.26)	9 (17.65)	21 (41.18)	30 (58.82)
统计值		t=0.156	χ²=0.188			χ²=0.004
P值		0.876	0.910			0.999
组别	合并症[例(%)]		尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
组别	阴囊分裂	阴茎阴囊转位	尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
传统组	17 (54.84)	13 (41.94)	5.8±0.4	14.4±1.7	14.48±0.18	13.00±0.15
改良组	31 (60.78)	23 (45.10)	5.6±0.3	14.4±1.8	14.47±0.15	13.96±0.11
统计值	χ²=0.281	χ²=0.078	t=0.484	t=0.003	t=0.055	t=0.218
P值	0.648	0.822	0.629	0.976	0.956	0.828

组别	例数	年龄[月，(±s)]	尿道开口[例(%)]			阴茎下曲[例(%)]
组别	例数	年龄[月，(±s)]	阴茎阴囊交界	阴囊	会阴	中度	重度
传统组	31	23.3±1.9	15 (48.39)	11 (35.48)	5 (16.13)	13 (41.94)	18 (58.06)
改良组	51	23.8±1.8	23 (45.10)	19 (37.26)	9 (17.65)	21 (41.18)	30 (58.82)
统计值		t=0.156	χ²=0.188			χ²=0.004
P值		0.876	0.910			0.999
组别	合并症[例(%)]		尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
组别	阴囊分裂	阴茎阴囊转位	尿道缺损[cm，(±s)]	阴茎头宽度[mm，(±s)]	总体住院时间[d，(±s)]	术后住院时间[d，(±s)]
传统组	17 (54.84)	13 (41.94)	5.8±0.4	14.4±1.7	14.48±0.18	13.00±0.15
改良组	31 (60.78)	23 (45.10)	5.6±0.3	14.4±1.8	14.47±0.15	13.96±0.11
统计值	χ²=0.281	χ²=0.078	t=0.484	t=0.003	t=0.055	t=0.218
P值	0.648	0.822	0.629	0.976	0.956	0.828

组别	例数	Ⅰ期		Ⅱ期
组别	例数	手术时间(min)	出血量(mL)	手术时间(min)	出血量(mL)
传统组	31	94.7±4.0	17.6±1.5	124.7±4.0	17.1±1.3
改良组	51	96.5±2.8	18.2±1.3	127.3±2.8	16.7±1.0
t值		0.361	0.319	0.532	0.256
P值		0.719	0.750	0.596	0.799

组别	例数	Ⅰ期		Ⅱ期
组别	例数	手术时间(min)	出血量(mL)	手术时间(min)	出血量(mL)
传统组	31	94.7±4.0	17.6±1.5	124.7±4.0	17.1±1.3
改良组	51	96.5±2.8	18.2±1.3	127.3±2.8	16.7±1.0
t值		0.361	0.319	0.532	0.256
P值		0.719	0.750	0.596	0.799

组别	例数	尿瘘[例(%)]			尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
组别	例数	冠状沟	阴茎阴囊交界处	其他部位	尿道憩室[例(%)]	阴茎下曲[例(%)]	尿道狭窄[例(%)]	阴茎头裂开[例(%)]	正位开口[例(%)]	HOPE评分(±s)	随访时间[月，(±s)]
传统组	31	4 (12.90)	2 (6.45)	3 (9.68)	3 (9.68)	2 (6.45)	3 (9.68)	4 (12.90)	26 (83.88)	7.94±0.30	74±7
改良组	51	0 (0)	5 (9.80)	9 (17.65)	2 (3.92)	1 (1.96)	5 (9.80)	0 (0)	51 (100)	8.75±0.15	75±5
统计值		χ²=6.918	χ²=0.278	χ²=0.980	χ²=1.116	χ²=1.103	χ²<0.001	χ²=6.918	χ²=8.760	t=2.636	t=0.087
P值		0.008	0.598	0.322	0.291	0.294	0.985	0.008	0.003	0.010	0.931

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