Preoperative hormonal stimulation effect on hypospadias repair complications: Meta-analysis of observational versus randomized controlled studies

Chua, Michael; Gnech, Michele; Ming, Jessica M.; Silangcruz, Jan Michael; Sanger, Stephanie; Lopes, Roberto Iglesias; Lorenzo, Armando J.; Braga, Luis H.

doi:10.1016/j.jpurol.2017.06.019

Cited by 28 publications

(20 citation statements)

References 32 publications

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“…The purpose of all the minimal modifications was to provide a tension-free, well-vascularized tubularized neourethra and improve postoperative wound healing (2). The existing modifications were only designed to improve external condition, such as soft tissue interposition, removal, increase length and width of rectangular flap and in situ tubularization of CES = continuous eversion suture; CIS = continuous inversion subepithelial; UF = cutaneous fistula; UD = urethral diverticulum; US = urethral stricture and BU = breakdown of urethral repair the transverse preputial island flap (3,9). Previous studies only mentioned that a well-vascularized neourethra and preputial flaps used for repair were exceptionally important for a successful outcome (10), but neglected how to improve intrinsic element of neourethra.…”

Section: Discussionmentioning

confidence: 99%

Comparison of continuous eversion and inverting subepithelial suture in transverse preputial island flap urethroplasty in proximal hypospadias repair: A retrospective study

et al. 2020

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Introduction: Transverse preputial island flap urethroplasty (TPIFU) is one of the most frequently performed technique for single-stage repair in proximal hypospadias. It was reported that the subepithelial urethroplasty would obviously decrease urethrocutaneous fistula (UF) complication after proximal TIP. But in the process of TPIFU, it had not been reported yet. Objective: We reviewed our experience to evaluate and compare the effect of continuous eversion suture (CES) versus continuous inversion subepithelial suture (CIS) on complication rates in the TPIFU. Material and methods: A retrospective review of all patients operated with CES and CIS in our institution between January 2017 and Jun 2017 was performed. Results: A total of 161 patients were enrolled in the research. Patients were followed up for 12~17 months. Total success rate was 73.9% (119/161). No statistically difference was found between the two groups with regard to age of patients (P=0.097), catheter size (P=0.52), time of catheterization (P=0.47), length of neourethra (P=0.20), non-urethral comorbidity (P=0.44) and post-operative infection (P=1.0). The overall postoperative complications had no statistically difference between the two groups (P=0.067). There were no statistically significant differences in the incidence of urethra-cutaneous fistula (UF) (OR=0.

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Section: Discussionmentioning

confidence: 99%

Comparison of continuous eversion and inverting subepithelial suture in transverse preputial island flap urethroplasty in proximal hypospadias repair: A retrospective study

et al. 2020

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“…Previous literature has identified that proximal hypospadias, a more severe phenotype of the condition, is linked to higher rates of complications post-operatively (19,20). Likewise, the hypospadias severity is an important confounding variable to consider a subgroup analysis to actually identify the causality or correlation of an intervention (21). In the choice of anesthesia, the subpopulations of proximal hypospadias are more likely to be given with caudal anesthesia over other anesthesia approach due to its more complex repair and long duration procedure.…”

Section: Tanseco Et Al Association Of Caudal Block and Postoperative Complication After Hypospadias Repairmentioning

confidence: 99%

Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis

Tanseco

Randhawa

Chua

et al. 2018

CUAJ

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Introduction: We performed a meta-analysis of the current literature to assess the association of caudal block and postoperative complication rates following hypospadias repair.Methods: A Systematic literature search was conducted on October 2017. Five reviewers independently screened, identified, and evaluated comparative studies assessing postoperative outcomes following hypospadias repair with and without caudal block. The incidence of post-surgical complications from each study was extracted for caudal block and control groups to generate the odds ratio (OR) and corresponding 95% confidence intervals (CI). Effect estimates were pooled using inverse-variance method with random-effects model. Subgroup analyses were performed according to study type and hypospadias severity.Results: Nine studies (2096patients) of low- to moderate-quality were included for meta-analysis. Overall pooled effect estimates demonstrated increased occurrence of postoperative complication rates among patients with caudal block (OR 2.32; 95% CI 1.29‒4.16). Subgroup analysis according to hypospadias severity revealed that a significant increased OR in complication rate was noted among proximal hypospadias (OR 3.55; 95% CI 1.80‒7.01), but not distal hypospadias (OR 1.31; 95% CI 0.59‒2.88).Conclusions: Our meta-analysis of poor-quality evidence may have revealed a significant association between caudal block and postoperative complications following hypospadias repair. However, subgroup analysis demonstrated that hypospadias severity is important in determining complication rates, suggesting that confounding factors and selection bias may play a central role in characterizing the true effect of the anesthesia approach.

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“…The current clinical practice guidelines published by the European Association of Urology and the European Association of Pediatric Urology provide no strong statement of recommendation on PHS with androgens as data are scarce on this specific issue. 1,2 To date, three systematic reviews have been published on the effects of using PHS for hypospadias repair on post-operative complications. In the first two systematic reviews, the odds ratios for a complication occurring with pre-operative hormonal stimulation use were reported as 1.67 (CI: 0.96-2.91, p = 0.07, I(2) = 0%) and 1.18 (95% CI: 0.70-2.00, Z = 0.91, p = 0.539) respectively.…”

Section: Introductionmentioning

confidence: 99%

“…A pooled effect estimate showed no significant difference between the treatment groups (RR 0.99, 95% CI: 0.63-1.55, p = 0.96). 1 As a result of these evaluations, it has been reported that there is a need for future studies on the molecular effects of testosterone at tissue level wound healing.…”

Section: Introductionmentioning

confidence: 99%

“…Pre‐operative hormonal stimulation (PHS) with androgens has been used in hypospadias repair with the aim to improve surgical outcomes and decrease the accompanying complications. The current clinical practice guidelines published by the European Association of Urology and the European Association of Pediatric Urology provide no strong statement of recommendation on PHS with androgens as data are scarce on this specific issue 1,2 …”

Section: Introductionmentioning

confidence: 99%

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Effects of systemic androgens on late‐stage urethral wound healing: An animal study

et al. 2022

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Background: There are limited data regarding the effects of systemic androgens on late-stage urethral wound healing.Objective: To evaluate the effects of systemic androgens on fibrosis and scar formation in late-stage urethral wound healing. Materials and methods:Forty-five male Sprague Dawley rats were divided into three groups. First group consisted of 15 rats that were castrated on 23 days of age and were given 5 mg/kg testosterone undecanoate with 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks (castrated and replaced with testosterone rats [CAS+T] group). The castrated rats (CAS) group included 15 castrated rats. The remaining 15 rats underwent sham surgery. CAS and sham groups also received 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks. Furthermore, all groups were divided into three subgroups after testosterone/placebo administration (urethroplasty performed after first, second, and third weeks) in accordance with the urethroplasty timing. All animals were sacrificed 6 weeks after urethroplasty. Serum testosterone level was measured, tissue samples were investigated using hematoxylin and eosin and Masson's trichrome. Alpha-SMA, Coll 1 and Coll 3 primary antibodies were applied for immunohistochemical examination. Expression of cytokines and growth factors, such as Bax, Bcl2, IL-10, IP-10, TNF-alpha, TGFb1, MMP9, Col-I, Col-III, TIMP-1, fibronectin, fibroblast growth factor 10, platelet-derived growth factor, alpha-SMA, were also evaluated in the tissues. Results:The blood testosterone levels were significantly higher in CAS+T group at the time of urethroplasty compared with the levels in CAS group; however, this difference was not observed at the time of sacrification (p < 0.001 and 0.97, respectively).Histological analysis with hematoxylin and eosin and Masson's trichrome staining revealed a significantly higher fibrosis in the sham group compared with the others.Significantly lower fibrosis was detected in the CAS group in the pairwise comparison of the pathological fibrosis area between the CAS and CAS+T groups (p < 0.001).

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Preoperative hormonal stimulation effect on hypospadias repair complications: Meta-analysis of observational versus randomized controlled studies

Cited by 28 publications

References 32 publications

Comparison of continuous eversion and inverting subepithelial suture in transverse preputial island flap urethroplasty in proximal hypospadias repair: A retrospective study

Comparison of continuous eversion and inverting subepithelial suture in transverse preputial island flap urethroplasty in proximal hypospadias repair: A retrospective study

Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis

Effects of systemic androgens on late‐stage urethral wound healing: An animal study

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