Yuan Yi, Wang Yu-Wen, Liang Yan-Nei, Wang Yu-Ying, Ho Jun-Jie, Peng Tong-Yu, Zhao Zhang, Deng Nan
Department of Urology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
The First Clinical College, Chongqing Medical University, Chongqing, China.
Front Pediatr. 2023 Jun 8;11:1091242. doi: 10.3389/fped.2023.1091242. eCollection 2023.
Urethrocutaneous fistula is one of the most common complications after urethroplasty. This meta-analysis aims to evaluate the superiority of double dartos flap to single dartos flap in preventing fistula during tubularized incised plate urethroplasty (TIPU), which is one of the most frequently used operations for hypospadias.
We extracted clinical trials under the following included criteria: (1) children with TIPU; (2) a comparison of single and double flap layer; and (3) record of complications with the following excluded criteria: (1) non-comparison and (2) lack of data. Finally, 13 studies from PubMed, Cochrane Library, Scopus, and Embase have been investigated, with a total of 1,185 patients from 2005 to 2022. The quality assessment was conducted according to the Cochrane handbook and the Newcastle-Ottawa scale. A mixed-effect model was utilized to weigh the risk of fistula, phallic rotation, meatal stenosis, and wound dehiscence by the Review Manager V.5.4 software.
The double dartos flap layer group excels in descending the risk of postoperative fistula [odds ratio (OR) = 9.56; 95% confidence interval (CI) (4.76, 19.22); < 0.00001] and phallic rotation [OR = 31.26; 95% CI (9.60, 101.84); < 0.00001], while there are no differences in the rate of meatal stenosis [OR = 1.49; 95% CI (0.73, 2.70); = 0.31] and wound dehiscence [OR = 2.30; 95% CI (0.80, 6.63); = 0.12].
The routine utility of a double dartos flap layer is recommended as a potential treatment during the tubularized incised plate urethroplasty.
identifier PROSPERO CRD42022366294.
尿道皮肤瘘是尿道成形术后最常见的并发症之一。本荟萃分析旨在评估在管状切开板尿道成形术（TIPU，这是治疗尿道下裂最常用的手术之一）中，双层肉膜瓣相对于单层肉膜瓣在预防瘘管形成方面的优越性。
我们根据以下纳入标准提取临床试验：（1）接受TIPU的儿童；（2）单层和双层肉膜瓣的比较；以及根据以下排除标准记录并发症：（1）非比较性研究；（2）数据缺失。最后，对来自PubMed、Cochrane图书馆、Scopus和Embase的13项研究进行了调查，共有2005年至2022年期间的1185例患者。根据Cochrane手册和纽卡斯尔-渥太华量表进行质量评估。使用混合效应模型，通过Review Manager V.5.4软件权衡瘘管形成、阴茎旋转、尿道口狭窄和伤口裂开的风险。
双层肉膜瓣组在降低术后瘘管形成风险方面表现出色[比值比（OR）=9.56；95%置信区间（CI）（4.76，19.22）；P<0.00001]和阴茎旋转风险[OR=31.26；95%CI（9.60，101.84）；P<0.00001]，而在尿道口狭窄发生率[OR=1.49；95%CI（0.73，2.70）；P=0.31]和伤口裂开发生率[OR=2.30；95%CI（0.80，6.63）；P=0.12]方面没有差异。
建议在管状切开板尿道成形术中常规使用双层肉膜瓣作为一种潜在的治疗方法。
标识符PROSPERO CRD42022366294。
