Escolino Maria, Caracò Maria Sofia, Mazzone Valerio, Di Mento Claudia, Carraturo Francesca, Perricone Flavio, Esposito Giovanni, Porcaro Mauro, Esposito Ciro
Division of Pediatric Surgery, Federico II University Hospital, 80131 Naples, Italy.
CEINGE Advanced Biotechnologies, 80131 Naples, Italy.
Medicina (Kaunas). 2025 Sep 12;61(9):1659. doi: 10.3390/medicina61091659.
: The optimal postoperative urinary diversion strategy after hypospadias repair remains debated, with variability in type, material, and duration. Pediatric-specific data are limited. This systematic review and meta-analysis aimed to evaluate how urinary diversion type and duration affected surgical outcomes after pediatric hypospadias repair. : A systematic search of PubMed, Embase and Cochrane Library (1995-2025) databases was conducted using PRISMA guidelines and registered in PROSPERO (CRD420251121638). Eligible studies included pediatric patients undergoing hypospadias repair with or without urinary diversion. Primary endpoints were diversion characteristics (type, material, duration); secondary endpoints included postoperative complications and re-operations. : A total of 31 studies representing 4261 pediatric patients were analyzed, with 16 included in meta-analysis. Pooled estimates confirmed that bladder catheters were associated with significantly higher rates of general complications (wound/urinary tract infections, swelling, foreskin dehiscence) [ < 0.05] and re-operations [ < 0.05] compared to urethral stents. Conversely, urethral stents showed a greater risk of mechanical complications such as blockage and dislodgement [ = 0.001]. Meta-analysis of stented versus unstented procedures revealed no significant differences in major outcomes (fistula, stenosis, re-operations), although stented repairs showed a modest increase in minor complications. For catheterization length, pooled data suggested no significant advantage of prolonged (>5 days) versus shorter (≤5 days) diversion, despite descriptive analyses indicating more functional and general complications [ < 0.05] and re-operations [ = 0.004] after short diversion and more fistulas after prolonged diversion [ < 0.05]. : Urinary diversion strategies significantly affected surgical outcomes after pediatric hypospadias repair. Urethral stents reduced general complications compared with bladder catheters but were prone to mechanical issues. Short diversion increased early complications, while prolonged catheterization increased fistula risk. No single approach proved universally superior; therefore, perioperative management should be individualized according to patient characteristics, hypospadias severity, and intraoperative findings. Further high-quality prospective trials are needed to define optimal diversion protocols.
尿道下裂修复术后的最佳尿流改道策略仍存在争议，在类型、材料和持续时间方面存在差异。儿科特异性数据有限。本系统评价和荟萃分析旨在评估尿流改道类型和持续时间如何影响小儿尿道下裂修复术后的手术结果。
使用PRISMA指南对PubMed、Embase和Cochrane图书馆（1995 - 2025年）数据库进行系统检索，并在PROSPERO（CRD420251121638）中注册。符合条件的研究包括接受或未接受尿流改道的小儿尿道下裂修复患者。主要终点是改道特征（类型、材料、持续时间）；次要终点包括术后并发症和再次手术。
共分析了代表4261例儿科患者的31项研究，其中16项纳入荟萃分析。汇总估计证实，与尿道支架相比膀胱导尿管与更高的一般并发症发生率（伤口/尿路感染、肿胀、包皮裂开）[P < 0.05]和再次手术率[P < 0.05]相关。相反，尿道支架显示出更高的机械并发症风险，如堵塞和移位[P = 0.001]。对带支架与不带支架手术的荟萃分析显示，主要结局（瘘管、狭窄、再次手术）无显著差异，尽管带支架修复的轻微并发症略有增加。对于导尿时间，汇总数据表明延长（>5天）与较短（≤5天）改道无显著优势，尽管描述性分析表明短时间改道后功能和一般并发症更多[P < 0.05]和再次手术更多[P = 0.004]，而长时间改道后瘘管更多[P < 0.05]。
尿流改道策略显著影响小儿尿道下裂修复术后的手术结果。与膀胱导尿管相比，尿道支架减少了一般并发症，但容易出现机械问题。短时间改道增加早期并发症，而长时间导尿增加瘘管风险。没有一种方法被证明普遍优越；因此，围手术期管理应根据患者特征、尿道下裂严重程度和术中发现进行个体化。需要进一步的高质量前瞻性试验来确定最佳改道方案。
