Borkar Nitinkumar, Tiwari Charu, Mohanty Debajyoti, Sinha Arvind, Upadhyaya Vijai Datta
Department of Paediatric Surgery, AIIMS, Raipur, India.
Department of General Surgery, AIIMS, Raipur, India.
Arab J Urol. 2022 Nov 22;21(3):177-184. doi: 10.1080/2090598X.2022.2149129. eCollection 2023.
There is unanimous agreement amongst hypospadias surgeons to use an intermediate layer to cover the neourethra. Dartos fascia and tunica vaginalis (TV) flaps are the most preferred tissues to be used. Tissue glue, sealants and biomaterials are also useful where there is a paucity of local tissue to cover the neourethra. But these blood-derived products have associated infectious and allergic risks. The autologous human platelet concentrate (APC) contains biologically active factors and is safe for wound healing and soft tissue reconstruction. It has been used by few surgeons as an intermediate layer in hypospadias repair. This systematic review and meta-analysis aim to systematically compare the outcomes of hypospadias surgery in children with or without using APCs.
This systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Meta-analysis protocol was registered with INPLASY. A systematic, detailed search was carried out by the authors in the electronic databases, including Medline, Embase, CENTRAL, Scopus, Google Scholar and clinical trial registry. Studies were selected and compared based on primary outcome measures like urethra-cutaneous fistula, meatal stenosis, wound infection and operative time. Statistical analysis was performed using a fixed-effect model, pooled risk ratio and I heterogeneity.
Four randomized studies with a total of 355 patients were included. Pooled analysis for outcome of urethra-cutaneous fistula (UCF) showed no significant difference between the groups with APC and without APC. Pooled analysis for the other outcome like meatal stenosis, wound infection and total complications showed a decrease in incidence of these complications in groups with APC.
This meta-analysis shows that there is a reduction in the incidence of wound infection, meatal stenosis and total complications in patients where APC was used to cover the neourethra, although no such difference was observed in UCF rates.
尿道下裂手术医生一致认为应使用中间层覆盖新尿道。肉膜筋膜和睾丸鞘膜（TV）皮瓣是最常选用的组织。当局部组织不足以覆盖新尿道时，组织胶水、密封剂和生物材料也很有用。但这些血液衍生产品存在感染和过敏风险。自体人血小板浓缩物（APC）含有生物活性因子，对伤口愈合和软组织重建安全。少数外科医生已将其用作尿道下裂修复的中间层。本系统评价和荟萃分析旨在系统比较使用或不使用APC的儿童尿道下裂手术的结果。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。荟萃分析方案已在INPLASY注册。作者在电子数据库中进行了系统、详细的检索，包括Medline、Embase、CENTRAL、Scopus、谷歌学术和临床试验注册库。根据尿道皮肤瘘、尿道口狭窄、伤口感染和手术时间等主要结局指标对研究进行选择和比较。使用固定效应模型、合并风险比和I2异质性进行统计分析。
纳入四项随机研究，共355例患者。对尿道皮肤瘘（UCF）结局的合并分析显示，使用APC组和未使用APC组之间无显著差异。对尿道口狭窄、伤口感染和总并发症等其他结局的合并分析显示使用APC组这些并发症的发生率降低。
本荟萃分析表明，使用APC覆盖新尿道的患者伤口感染、尿道口狭窄和总并发症的发生率降低，尽管在UCF发生率方面未观察到此类差异。
