Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, 400053, India.
Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India.
J Pediatr Urol. 2022 Feb;18(1):39-46. doi: 10.1016/j.jpurol.2021.10.004. Epub 2021 Oct 20.
This systematic review and meta-analysis aimed to define the current evidence and systematically summarize the relevant data regarding the utility and safety of hyperbaric oxygen therapy (HBOT) as an adjunctive treatment in complicated re-operative cases of hypospadias.
The authors systematically searched the PubMed, EMBASE, Web of Science, and Scopus databases on August 5, 2021. Patients were divided into two groups, i.e. HBOT and non-HBOT. The main outcomes were graft failure rate and the incidence of complications following urethroplasty. The proportion of patients developing adverse events due to HBOT was the secondary outcome. The pooled risk ratio and heterogeneity were calculated using the Mantel-Haenszel method and the I statistics respectively. The quality assessment of the included studies was performed using the Downs and Black scale.
Four studies constituting 176 patients (101 in the HBOT group) were included (Figure). Variations were observed among these studies in terms of the age of participants, the number and types of previous operations performed, and the protocol of administration of HBOT. The graft failure rate (RR 0.19; 95% CI 0.05-0.73, p = 0.02) and the incidence of complications (RR 0.40, 95% CI 0.20-0.77, p = 0.007) were significantly low in the HBOT versus the non-HBOT group. Apart from myringotomy insertion (n = 10; 9.9%) and claustrophobia (n = 1), no other adverse events were associated with HBOT. All studies had a moderate risk of bias. An almost perfect agreement (kappa = 0.956, p < 0.0001) was observed between the two investigators assessing the risk of bias.
The present systematic review and meta-analysis significantly favor the administration of HBOT versus no HBOT in terms of graft failure rate and incidence of complications following urethroplasty. The available data also highlights the safety of HBOT in complicated cases of hypospadias. However, well-designed randomized controlled trials need to be conducted for an optimal comparison between the two treatment groups.
本系统评价和荟萃分析旨在确定目前的证据，并系统地总结有关高压氧治疗（HBOT）作为尿道下裂复杂再手术辅助治疗的效用和安全性的相关数据。
作者于 2021 年 8 月 5 日系统地检索了 PubMed、EMBASE、Web of Science 和 Scopus 数据库。患者分为两组，即 HBOT 组和非 HBOT 组。主要结局是移植物失败率和尿道成形术后并发症的发生率。因 HBOT 发生不良事件的患者比例为次要结局。使用 Mantel-Haenszel 方法和 I 统计量分别计算合并风险比和异质性。使用 Downs 和 Black 量表对纳入研究进行质量评估。
共有 4 项研究（HBOT 组 101 例）纳入 176 例患者（图）。这些研究在参与者的年龄、先前手术的次数和类型以及 HBOT 给药方案方面存在差异。HBOT 组的移植物失败率（RR 0.19；95%CI 0.05-0.73，p=0.02）和并发症发生率（RR 0.40，95%CI 0.20-0.77，p=0.007）显著低于非 HBOT 组。除了鼓膜切开术（n=10；9.9%）和幽闭恐惧症（n=1）外，HBOT 与其他不良事件无关。所有研究的偏倚风险均为中度。两名评估者对偏倚风险的评估存在几乎完美的一致性（kappa=0.956，p<0.0001）。
本系统评价和荟萃分析表明，与不给予 HBOT 相比，HBOT 可显著降低尿道成形术后移植物失败率和并发症发生率。现有数据还突出了 HBOT 在尿道下裂复杂病例中的安全性。然而，需要进行精心设计的随机对照试验，以在两组治疗之间进行最佳比较。
