Complications Following Primary Repair of Non-proximal Hypospadias in Children: A Systematic Review and Meta-Analysis

Abstract

Purpose: The aim of this study was to systematically review the literature on the complications and postoperative outcomes of children with non-proximal hypospadias.Methods: Electronic databases including PubMed, Embase, and Cochrane Library CENTRAL were searched systematically from January 1990 to June 2020 for the literature that reported the postoperative outcomes of patients with non-proximal hypospadias. Non-proximal hypospadias encompassed distal and mid-penile hypospadias.Results: We included 44 studies involving 10,666 subjects. Urethrocutaneous fistula (UCF) was the most common complication with an incidence of 4.0% (95% CI, 3.1–5.0%). Incidence of overall complications was 8.0% (95% CI, 6.3–9.8%). Meta-regression analysis revealed that length of urethral stent indwelling (coefficient 0.006; 95% CI, 0.000–0.011; p = 0.036) and penile dressing (coefficient 0.010; 95% CI, 0.000–0.021; p = 0.048) were two risk factors for UCF. Multivariate meta-regression analysis did not identify any independent risk factors for UCF. No differences were found between stent and stentless groups in non-proximal hypospadias regarding incidences of UCF (OR, 0.589; 95% CI, 0.267–1.297), meatal stenosis (OR, 0.880; 95% CI, 0.318–2.437), and overall complications (OR, 0.695; 95% CI, 0.403–1.199). No differences were found between foreskin preservation and circumcision in terms of complications either.Conclusions: UCF is the most common complication following hypospadias repair with an incidence of 4.0%. Independent risk factors for UCF were not identified in the current research. Distal hypospadias repair without stent indwelling is not likely to compromise the postoperative outcome. Further studies should be designed to explore the differences between different surgical approaches and the potential risk factors for complications following hypospadias repair.

Urethral Plate Characteristics in Cases of Non-proximal Hypospadias May Not Be Associated With a Higher Risk of Complications When a Two-Stage Repair Is Applied

“…Nevertheless, the complication rates in our study remain far below the average complication rates of non-proximal hypospadias repair in children. In particular, the systematic meta-analysis of published studies of non-proximal hypospadias repair techniques revealed an overall complication rate of approximately 8% (25). Urethrocutaneous fistula was, as expected, the primary complication reported, with an incidence of 4%, followed by meatal stenosis with 2.1% and urethral stricture with 0.8%.…”

Predictive Value of C-Reactive Protein for Early Postoperative Complications in Children After Hypospadias Surgery

“…Surgery is the only cure for hypospadias, and the repair of hypospadias aims to create a straight penis, a neourethra with a meatus at the tip of glans, and a normal appearance of a circumcised phallus ( 7 , 8 ). However, long-term follow-up studies have found that adults with hypospadias may have abnormal urethral function, unsatisfactory appearance of the penis, and problems with erection, ejaculation, or sexual intercourse, which often negatively affect their quality of life ( 9 ).…”

Complications after Hypospadias Repair: Are We Adequately Counseling Families?

“…A 2020 systematic review and meta-analysis of primary, nonproximal hypospadias repair reported an overall complication rate of 8.0%, with the most common complication being urethrocutaneous fistula. 1 Complications after proximal hypospadias have been reported to occur with greater frequency. Single-center series assessing 2-stage proximal hypospadias repairs demonstrate overall complication rates of 49% and 53%, with median followup times of 31.7 months and 3.8 years, respectively.…”