Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft &amp; foreskin pedicled flap) repair for proximal hypospadias in the last decade

Babu, Ramesh; Chandrasekharam, V.V.S.

doi:10.1016/j.jpurol.2021.05.014

Cited by 27 publications

(22 citation statements)

References 41 publications

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“…Therefore, the treatment of severe hypospadias is a great challenge for pediatric urologists. There are different opinions on the choice of single-stage versus staged operations [ 2 , 3 ]. We believe that the experience of the surgeon and the severity of hypospadias are the main determinants.…”

Section: Introductionmentioning

confidence: 99%

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Lin

Wang

et al. 2021

BMC Urol

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Background We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. Methods Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. Results Both groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). Conclusions Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

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Section: Introductionmentioning

confidence: 99%

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Lin

Wang

et al. 2021

BMC Urol

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“…The 20 recent articles [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] on meta-analyses were published in the JPUrol between October 9, 2017, and May 17, 2021. Of these, only seven [19][20][21][22][23][24][25] were included for the calculation of FI.…”

Section: Resultsmentioning

confidence: 99%

“…Of these, only seven [19][20][21][22][23][24][25] were included for the calculation of FI. The remaining were excluded as they incorporated non-comparative studies [6][7][8][9][10][11][12][13][14][15][16][17] and/or none of the defined methods for pooling the estimates (Mantel-Haenszel or inverse variance or Peto) were identified in them [6][7][8][9][10][11][12][13][14][15][16][17][18]. Among the seven included studies, there were 22 individual meta-analyses.…”

Section: Resultsmentioning

confidence: 99%

Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

Anand¹,

Kainth²

2021

Cureus

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Background and objectiveFragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). MethodTwenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. ResultsA total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. ConclusionBased on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.

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“…The two-stage procedure is considered as a method to reduce the difficulty of surgery, in terms of increasing the available prepuce, tissue vascularity and providing a healthier urethral bed for the second stage surgery [ 28 ]. Reportedly, it has relatively low risk of complications [ 6 , 27 , 29 , 30 ]. However, compared with two-stage urethroplasty, most of the patients can avoid re-operation who undergo a single-stage urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

A new modified Duckett urethroplasty for repair of proximal hypospadias with severe chordee: outcomes of 133 patients

Wang

Zhang

et al. 2022

BMC Urol

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Background Despite the continuous development and evolution of surgical methods and techniques, proximal hypospadias remains one of the most challenging issues for pediatric urologists. This study aims to evaluate the indications and postoperative complications of our new modified Duckett urethroplasty. Methods A total of 133 patients with proximal hypospadias who underwent repair of the modified Duckett urethroplasty from February 2016 to February 2021 were reviewed. The median age of patients was 3 years (range 1–16). All patients had severe chordee. One senior experienced pediatric urologist performed all the surgeries. Catheter was removed 14 days after the surgery. Results The location of the urethral meatus was proximal penile in 26 patients (19.5%), penoscrotal in 60 (45.1%), scrotal in 31 (23.3%), and perineal in 16 (12.0%). The mean length of the urethral defect was 4.5 cm (range 2.5–10). The median duration of follow-up was 46 months (range 8–67). Complications occurred in 31 patients (23.3%), including urethra-cutaneous fistula in 22 (16.5%), urethral stenosis in 7 (5.3%), and urethral diverticulum in 2 (1.5%). No recurrent chordee were found in all cases. All patients who developed complications were treated successfully at our hospital. Conclusions Our modified Duckett urethroplasty showed functionally and cosmetically favorable outcomes, with a lower incidence of postoperative complications. To the best of our knowledge, the novel Duckett technique is a feasible and suitable option for patients who suffer from proximal hypospadias with severe chordee and dysplasia of the urethral plate.

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Meta-analysis comparing the outcomes of single stage (foreskin pedicled tube) versus two stage (foreskin free graft & foreskin pedicled flap) repair for proximal hypospadias in the last decade

Cited by 27 publications

References 41 publications

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

Fragility Index of Recently Published Meta-Analyses in Pediatric Urology: A Striking Observation

A new modified Duckett urethroplasty for repair of proximal hypospadias with severe chordee: outcomes of 133 patients

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