The comparison of interrupted and continuous suturing technique in Snodgrass urethroplasty in patients with primary hypospadias: A systematic review and meta-analysis

Abstract

Background: Hypospadias is among the common congenital anomalies in boys. Snodgrass urethroplasty is one of the most popular techniques for correcting distal and mid hypospadias. Although there is consensus among pediatric surgeons on using absorbable sutures for urethroplasty, there are no established guidelines about the suturing techniques (interrupted suturing [IS] or continuous suturing [CS]) for neourethra creation in Snodgrass urethroplasty. This analysis aims to compare the reported outcomes of both the urethroplasty suturing techniques. Materials and Methods: This systematic review and meta-analysis was conducted as per the preferred reporting items for systematic review and meta-analyses guidelines. A systematic, detailed search was carried out by the authors in the electronic databases – MEDLINE, PubMed Central, Scopus, Google Scholar, and Clinical Trial Registry. Studies were selected and compared based on primary outcomes – development of urethrocutaneous fistula (UCF), meatal stenosis, and secondary outcomes – wound infection, urethral stricture, and operative time. Statistical analysis was performed using a fixed-effect model, pooled risk ratio, and I 2 heterogeneity. Results: Five randomized studies with a total of 521 patients met our inclusion criteria. Pooled analysis for total complications, UCF, meatal stenosis, and wound infection showed no significant difference between the CS and IS groups. Subgroup analysis of patients with the use of polyglactin sutures showed a decrease in total complications and UCF in the IS group. Conclusion: There is no difference in total complication rates among the CS and the IS group with the use of absorbable sutures in Snodgrass urethroplasty; however, there is a decrease in the incidence of total complications and UCF in the IS group when polyglactin was preferred over polydioxanone suture for urethroplasty.

A Thorough Analysis of The Effects and Complications of Two Different Suturing Techniques in Hypospadias Repair Using Tubularized-Incised Plate Urethroplasty: a Meta-Analysis

“…There was no statistically significant difference between continuous and interrupted suture groups in the surgical site infection outcome analysis. This finding is consistent with previous meta-analyses ( 12 , 13 ). The number of postoperative hypospadias wound infections tended to be higher in the group with continuous sutures, but this difference did not reach statistical significance.…”

“…However, the incidence of postoperative urethrocutaneous fistulas was statistically higher in the group with continuous sutures. A similar result has been reported in previous meta-analyses ( 12 , 13 ).…”

“…The authors explained that the high rate of complications with interrupted sutures is due to the subcuticular suture method used and the urethral plate edges being closer together in continuous than interrupted sutures ( 4 , 7 - 11 ). Previous meta-analysis studies by Wahyudi et al, and Borkar et al found that neither suturing technique was significantly associated with complications ( 12 , 13 ). However, Borkar et al reported a higher rate of complications in the continuous suture group ( 13 ).…”

“…Previous meta-analysis studies by Wahyudi et al, and Borkar et al found that neither suturing technique was significantly associated with complications ( 12 , 13 ). However, Borkar et al reported a higher rate of complications in the continuous suture group ( 13 ). This would imply that surgical measures for reducing complications are still the most important factor, including cautious tissue handling, a second layer of neourethral coverage, tension-free repair, and magnification ( 12 ).…”

Post-urethroplasty complications in hypospadias repair: a systematic review and meta-analysis comparing polydioxanone and polyglactin sutures

“…This study was excluded from our meta-analysis due to a difference in the suturing technique, which can act as a confounding factor for UCF development as per a recent meta-analysis. 26 In our quantitative analysis, there is heterogeneity in suturing technique among the different studies but not among the PDS and PG groups. Almost all studies using animal models had discouraged PDS for hypospadias repair to minimize the incidence of UCF; however, our meta-analysis shows a decreased incidence of UCF with PDS.…”