Cousin Ianis, Basmaison Camille, Cousin Elie, Lebonvallet Nicolas, Germouty Isabelle, Leven Cyril, De Vries Philine
Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foch, 29200 Brest, France; Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France.
Laboratoire Intéraction épithéliums Neurones, Université de Bretagne Occidentale, 6 Rue Colbert, 29200 Brest, France.
J Pediatr Urol. 2022 Oct;18(5):587-597. doi: 10.1016/j.jpurol.2022.08.005. Epub 2022 Aug 17.
Proximal hypospadias surgery is impacted by a high complication rate. The goal of this work was to assess the overall composite complication rate, fistula rate and stenosis rate following proximal hypospadias surgery realized according to onlay urethroplasty, Duckett, Koyanagi and Bracka techniques.
The databases MEDLINE, EMBASE, SCOPUS, Cochrane Library, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) and Sciencedirect were searched. Studies had to report data about the mean age of population, the average duration of patient follow-up and the number of procedures required for surgical treatment of primary and proximal hypospadias. Two independent including one urologist reviewers screened all the articles and selected the articles to be included.
Overall composite complication rates were 32%, 34%, 49%, and 43%, for Onlay urethroplasty, Duckett's tubularized flaps urethroplasty, Koyanagi repair and Bracka 2 stages repair, respectively. Fistula rates were 13%, 18%, 21% and 23% respectively. The heterogeneity of complication rates reported in the different studies was not moderated by age, country, or patient's continent origin.
The classifications of complications used in articles were disparate and make comparisons between techniques difficult. The report of post-surgical complications in the literature is often poorly coded and follow-up times were often too short.
This meta-analysis attempts to determine to the extent possible, given the serious weaknesses in the hypospadias literature, plausible estimates of complication rates after skin flap urethroplasty. The patched onlay skin flap, the Duckett's tubularized skin flap technique, the Koyanagi's technique, and the Bracka's two-stage urethroplasty procedure lead to very high complication rates. Reported complication rates are comparable across techniques.
近端尿道下裂手术受到高并发症发生率的影响。本研究的目的是评估采用覆盖法尿道成形术、达科特（Duckett）术式、小柳（Koyanagi）术式和布拉卡（Bracka）术式进行近端尿道下裂手术后的总体综合并发症发生率、瘘管发生率和狭窄发生率。
检索了MEDLINE、EMBASE、SCOPUS、Cochrane图书馆、Cochrane系统评价数据库和Cochrane对照试验中心注册库（CENTRAL）以及ScienceDirect数据库。研究必须报告有关人群平均年龄、患者随访平均时长以及原发性和近端尿道下裂手术治疗所需手术次数的数据。两名独立评审员（其中一名是泌尿科医生）筛选了所有文章并选择纳入的文章。
覆盖法尿道成形术、达科特管状皮瓣尿道成形术、小柳修复术和布拉卡两阶段修复术的总体综合并发症发生率分别为32%、34%、49%和43%。瘘管发生率分别为13%、18%、21%和23%。不同研究报告的并发症发生率的异质性不受年龄、国家或患者所在大洲的影响。
文章中使用的并发症分类各不相同，使得不同技术之间难以进行比较。文献中关于术后并发症的报告编码往往不佳，随访时间通常也过短。
鉴于尿道下裂文献存在严重缺陷，本荟萃分析试图尽可能确定皮瓣尿道成形术后并发症发生率的合理估计值。补片覆盖皮瓣、达科特管状皮瓣技术、小柳技术和布拉卡两阶段尿道成形术的并发症发生率都非常高。各技术报告的并发症发生率相当。
