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Development of a clinical prediction model for postoperative complications following tubularized incised plate
YiWei Fang1, Dan Yang2, Ning Sun3
1Department of Urology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
Purpose:
This multicenter study aimed to identify risk factors for postoperative complications following tubularized incised plate urethroplasty (TIP) in hypospadias patients and develop a clinical prediction model.
Methods:
Retrospective data from 17 tertiary centers (2018-2021) were analyzed.
Inclusion Criteria:
primary TIP surgery with complete anatomical and follow-up data.
Exclusion Criteria:
prior urethral surgery, genetic disorders, or incomplete records. Multivariate logistic regression identified independent predictors. A nomogram model was constructed and internally validated using bootstrapping (1000 resamples). Discrimination (AUC) and calibration (Hosmer-Lemeshow test) were assessed.
Results:
Among 493 patients (median follow-up: 42 months), the complication rate was 23.7% (117/493), including urethrocutaneous fistula (17.6%), stricture (6.5%), and diverticulum (2.8%). Independent predictors were: post-incision urethral plate width (OR: 0.01, 95% CI 0-0.05), glans width (OR: 0.81, 95% CI 0.66-0.98), and urethral defect length (OR: 1.47, 95% CI 1.00-2.16). The nomogram demonstrated moderate discrimination (AUC: 0.723, 95% CI 0.668-0.777) and good calibration (Hosmer-Lemeshow P = 0.382).
Conclusion:
A clinical prediction model incorporating post-incision urethral plate width, glans width, and urethral defect length showed acceptable predictive accuracy for TIP complications.
