Choudhury Prativa, Saroya Komal Kaur, Jain Vishesh, Yadav Devendra Kumar, Dhua Anjan Kumar, Anand Sachit, Mawar Shashi, Verma Vivek, Kapahtia Siddharth, Acharya Sameer Kant, Shah Rasik, Bajpai Minu, Goel Prabudh
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Surg Int. 2023 Apr 3;39(1):165. doi: 10.1007/s00383-023-05405-1.
To summarize the available evidence and to quantitatively evaluate the global results of different waterproofing layers in substantiating the UCF repair.
After defining the study protocol, the review was conducted according to the PRISMA guidelines by a team comprising experts in hypospadiology, systematic reviews and meta-analysis, epidemiology, biostatistics and data science. Studies published from 2000 onwards, reporting on the results of UCF closure after hypospadias repair were searched for on PUBMED, Embase and Google Scholar. Study quality was assessed using Joanna Briggs Checklist (JBI) critical appraisal tool. The results with different techniques were compared with the two samples independent proportions test with the help of Microsoft Excel, MedCalc software and an online calculator.
Seventy-three studies were shortlisted for the synthesis; the final analysis included 2886 patients (71 studies) with UCF repair failure in 539. A summary of various dimensions involved with the UCF repair has been generated including time gap after last surgery, stent-vs-no stent, supra-pubic catheterization, suture material, suturing technique, associated anomalies, complications, etc. The success rates associated with different techniques were calculated and compared: simple catheterization (100%), simple primary closure (73.2%), dartos (78.8%), double dartos flaps (81%), scrotal flaps (94.6%), tunica vaginalis (94.3%), PATIO repair (93.5%), biomaterials or dermal substitutes (92%), biocompatible adhesives (56.5%) and skin-based flaps (54.5%). Several techniques were identified as solitary publications and discussed.
Tunica vaginalis and scrotal flaps offer the best results after UCF closure in the synthesis. However, it is not possible to label any technique as ideal or perfect. Almost all popular waterproofing layers have depicted absolute (100%) success sometimes. There are a vast number of other factors (patient's local anatomy, surgeon's expertise and technical perspectives) which influence the final outcome.
总结现有证据，并定量评估不同防水层在证实尿道下裂修复术中尿道板修复（UCF）的整体效果。
在确定研究方案后，由一组包括尿道下裂学、系统评价与荟萃分析、流行病学、生物统计学和数据科学等领域专家的团队，按照PRISMA指南进行综述。在PUBMED、Embase和谷歌学术上检索2000年以后发表的关于尿道下裂修复术后尿道板闭合结果的研究。使用乔安娜·布里格斯检查表（JBI）批判性评估工具评估研究质量。借助Microsoft Excel、MedCalc软件和在线计算器，通过两样本独立比例检验比较不同技术的结果。
73项研究被筛选出来用于综合分析；最终分析纳入了2886例患者（71项研究），其中539例尿道板修复失败。已生成了与尿道板修复相关的各个方面的总结，包括上次手术后的时间间隔、使用支架与不使用支架、耻骨上导尿、缝合材料、缝合技术、相关畸形、并发症等。计算并比较了不同技术的成功率：单纯导尿（100%）、单纯一期缝合（73.2%）、肉膜（78.8%）、双肉膜瓣（81%）、阴囊瓣（94.6%）、鞘膜（94.3%）、PATIO修复（93.5%）、生物材料或真皮替代物（92%）、生物相容性粘合剂（56.5%）和皮瓣（54.5%）。有几种技术被确定为单独发表的研究并进行了讨论。
在综合分析中，鞘膜和阴囊瓣在尿道板闭合术后效果最佳。然而，不可能将任何一种技术标记为理想或完美的。几乎所有流行的防水层有时都显示出绝对（100%）的成功率。还有大量其他因素（患者的局部解剖结构、外科医生的专业知识和技术观点）会影响最终结果。
