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% (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).

A clinical prediction model incorporating post-incision urethral plate width, glans width, and urethral defect length showed acceptable predictive accuracy for TIP complications.