Pezzoli Marta, Lo Re Mattia, Carletti Virginia, Masieri Lorenzo, Mantovani Alberto
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
Pediatr Surg Int. 2025 Aug 1;41(1):240. doi: 10.1007/s00383-025-06134-3.
This systematic review assesses the impact of different second-layer coverage techniques on complication rates following primary tubularized incised plate urethroplasty (TIPU) for distal and midpenile hypospadias. A systematic search of PubMed, EMBASE, Cochrane Central, and Scopus was conducted in August 2024. Studies were included if they reported outcomes of single- or double-layer neourethral coverage in primary TIPU for distal or midpenile hypospadias. A narrative synthesis was performed due to study heterogeneity. Forty studies met inclusion criteria. In distal hypospadias, single-layer coverage yielded urethrocutaneous fistula (UCF) rates below 10% in most cases. Meatal stenosis reached 33.3% but was uncommon with dorsal dartos (DD) flaps. Double-layer coverage, especially with double DD flaps, showed lower UCF rates (0-12)% and minimal stenosis. For midpenile hypospadias, single-layer coverage showed higher UCF rates (0-36.4%), with DD flaps performing worse (12.5-36.4%) than tunica vaginalis (TV) flaps (0-3.1%). Double-layer techniques consistently reduced UCF to < 5%, with double DD flaps showing no fistula or stenosis. In conclusion, second-layer coverage, particularly double layer, reduces complications in TIPU. The DD flap remains most commonly used due to its accessibility, while the technically demanding TV flap shows promising results. Further high-quality data are needed to identify the optimal technique.
本系统评价评估了不同的第二层覆盖技术对远端和阴茎中段尿道下裂一期管状切开板尿道成形术（TIPU）后并发症发生率的影响。2024年8月对PubMed、EMBASE、Cochrane Central和Scopus进行了系统检索。如果研究报告了远端或阴茎中段尿道下裂一期TIPU中单层或双层新尿道覆盖的结果，则纳入研究。由于研究的异质性，进行了叙述性综合分析。40项研究符合纳入标准。在远端尿道下裂中，大多数情况下单层覆盖的尿道皮肤瘘（UCF）发生率低于10%。尿道口狭窄发生率达33.3%，但背侧肉膜（DD）皮瓣少见。双层覆盖，尤其是双DD皮瓣，显示出较低的UCF发生率（0 - 12）%，且狭窄极少。对于阴茎中段尿道下裂，单层覆盖显示出较高的UCF发生率（0 - 36.4%），DD皮瓣（12.5 - 36.4%）比鞘膜（TV）皮瓣（0 - 3.1%）效果更差。双层技术持续将UCF降低至<5%，双DD皮瓣无瘘或狭窄。总之，第二层覆盖，尤其是双层覆盖，可降低TIPU的并发症。由于其易获取性，DD皮瓣仍是最常用的，而技术要求较高的TV皮瓣显示出有前景的结果。需要进一步的高质量数据来确定最佳技术。
