The Role of Postoperative Dressing in Hypospadias Surgery: A Systematic Review and Meta-analysis of the Pediatric Literature

Abstract

Introduction: This study aimed to describe the available dressings and their management in patients undergoing hypospadias repair and compare post-operative outcomes with and without dressing and between the different dressing types. Materials and Methods: A comprehensive electronic literature search of PubMed, Embase, and Cochrane Library was conducted to obtain studies, published in the period 1990-2021, reporting on the dressing used following hypospadias surgery. All information regarding the dressing were considered as primary end points whereas surgical outcomes were assessed as secondary outcomes. Results: Thirty-one studies containing 1790 subjects undergoing hypospadias repair were included. Dressings were divided into 3 categories: non-adherent to the wound, adherent to the wound and glue-based dressings. Most authors preferred to remove/change the dressing in the ward and the median time of removal/change was 6.56 post-operative days. The dressing removal appeared as the most frequent factor generating parental anxiety. The median rate of wound-related complications was 8.18%, of urethroplasty complications 9.08% and of re-operations 8.18%. Metanalysis of outcomes showed higher risk of re-operations using conventional dressing, with no differences in urethroplasty and wound-related complications rates between conventional and glue-based dressings. Furthermore, use of dressing reported increased risk of wound-related complications compared with no dressing, without significant differences regarding occurrence of urethroplasty complications and re-operations. Conclusions: The current evidence confirmed that there is no difference in outcomes of hypospadias repair depending on a certain dressing type. To date, surgeon’s preference remains the main factor determining the choice for a specific dressing or for no dressing at all.

Postoperative care in hypospadias. Common practices and evidence available

“…However, some authors suggest that excessive pressure could interfere with blood flow and cause complications. A recent meta-analysis by the Naples team concluded that there is no quality evidence in favor of one option or the other, and that it cannot be claimed that not using any type of dressing proves beneficial in any way (7) . Therefore, the choice in terms of dressing should be made at the surgeon's discretion and according to patient needs.…”

Cuidados postoperatorios en el hipospadías. Prácticas habituales y evidencia disponible

“…No obstante, algunos autores defienden que una presión excesiva podría interferir con el riego sanguíneo y provocar complicaciones. Un reciente metaanálisis del equipo de Nápoles concluye que no hay evidencia de calidad a favor de una opción y otra y que no pueden afirmar que el no poner ningún tipo de vendaje suponga un beneficio (7) . Finalmente afirman que ha de quedar a la elección del cirujano el vendaje que más se adecue a las necesidades de cada paciente.…”