Testosterone prior to hypospadias repair: Postoperative complication rates and long-term cosmetic results, penile length and body height

et al. 2020

Preprint

Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in TIP repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis. But there is limited for other hypospadias operative techniques and fistula repair. registration number: PROSPERO CRD42019148554

Section: Discussionsupporting

confidence: 85%

A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

et al. 2020

Preprint

“…The total UCF rate is 7.71% in our study, consistent with the 7.5% incidence in a systematic review[2]. Patients age, glans size, urethral defect length, urethral operation history, surgical procedure, type of surgical repair, chordee degree, magification technique, caudal anesthesia, preoperative hormonal stimulation and other many factors are may related to the development of UCF and other complications postoperatively[21][22][23][24][25]. Additional soft coverages on the neourethra are also introduced to avoid these complications especially for decreasing the incidence of postoperative UCF.…”

supporting

confidence: 86%

A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

et al. 2020

Preprint

Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in hypospadias and fistula repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis.

“…In our study, the incidence of urethrocutaneous fistula was 9.63%, followed by meatal/urethral stenosis (4.25%), consistent with the 7.50% (fistula) and 4.40% (stenosis) incidence rates in a systematic review [ 22 ]. Patient age, glans size, urethral defect length, urethral operation history, surgical procedure, type of surgical repair, chordee degree, magnification technique, caudal anesthesia, preoperative hormonal stimulation, and other many factors may relate to the development of complications postoperatively [ 21 – 25 ]. Additional soft coverages on the neourethra are also introduced to avoid these complications, especially to decrease the incidence of postoperative urethrocutaneous fistula.…”

Section: Discussionmentioning

confidence: 99%

Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies

et al. 2020

BMC Urol

Background Tubularized incised plate (TIP) urethroplasty is the most commonly performed procedure for hypospadias. Several flap procedures have been recommended to decrease the postoperative complication rate in TIP repair, but no single flap procedure is ideal. This study aimed to compare the outcomes of dartos fascia (DF) and tunica vaginalis fascia (TVF) as intermediate layers in TIP urethroplasty. Methods We searched PubMed, EMBASE, the Cochrane Library, Web of Science, clinicaltrials.gov, and other sources for comparative studies up to April 16, 2020. Studies were selected by the predesigned inclusion criteria. The primary outcomes were postoperative complications. The secondary outcomes were functional and cosmetic outcomes. Results The pooled RR with 95% CI were calculated. We extracted the relevant information from the included studies. Only 6 comparative studies were included. No secondary outcomes were reported. The RR of the total complications rate for DF was 2.41 (95% CI 1.42–4.07, P = 0.0001) compared with TVF in TIP repair. For each postoperative complication, the RRs were 6.48 (2.20–19.12, P = 0.0007), 5.95 (1.13–31.30, P = 0.04), 0.62 (0.25–1.52, P = 0.29), and 0.75 (0.23–2.46, P = 0.64) for urethrocutaneous fistula, prepuce-related complications, meatal/urethral stenosis, and wound-related complications, respectively. Conclusions This meta-analysis reveals that compared to DF, TVF is a better option in TIP repair in terms of decreasing the incidence of the total postoperative complications, urethrocutaneous fistula, and prepuce-related complications. However there is limited evidence for functional and cosmetic outcomes. Overall, larger prospective studies and long-term follow-up data are required to further demonstrate the superiority of TVF over DF. Trial registration PROSPERO CRD42019148554.