Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis

Mesrur Selcuk Silay; Lisette 't Hoen; Nikita Bhatt; Josine Quaedackers; Guy Bogaert; Hasan Serkan Dogan; Rien J M Nijman; Yazan Rawashdeh; Raimund Stein; Serdar Tekgul; Christian Radmayr

doi:10.1016/j.jpurol.2021.02.013

Are there any benefits of using an inlay graft in the treatment of primary hypospadias in children? A systematic review and metanalysis

J Pediatr Urol. 2021 Jun;17(3):303-315. doi: 10.1016/j.jpurol.2021.02.013. Epub 2021 Feb 19.

Authors

Affiliations

¹ Division of Pediatric Urology, Deparment of Urology, Biruni University, Istanbul, Turkey. Electronic address: selcuksilay@gmail.com.
² Erasmus MC, Department of Urology, Rotterdam, the Netherlands.
³ Urology Registrar, East of England Deanery, Cambridge, United Kingdom.
⁴ Department of Urology and Pediatric Urology, University Medical Centre Groningen, University of Groningen, the Netherlands.
⁵ Department of Urology, University of Leuven, Belgium.
⁶ Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey.
⁷ Department of Urology, Aarhus, Denmark.
⁸ Department of Pediatric, Adolescent and Reconstructive Urology, University of Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁹ Department of Urology, Medical University of Innsbruck, Austria.

PMID: 33691984
DOI: 10.1016/j.jpurol.2021.02.013

Abstract

Introduction: Dorsal inlay graft urethroplasty (DIGU) has been described as an effective method for hypospadias repair with the proposed advantage of reducing the risk of complications. We aimed to systematically assess whether DIGU has any additional advantages over standard tubularized incised plate urethroplasty (TIPU) repair in children with primary hypospadias.

Materials and methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The a priori protocol is available at the PROSPERO database (CRD42020168305). A literature search was conducted for relevant publications from 1946 until January 10, 2020 in seven different databases. Randomized controlled trials (RCTs), comparative studies (TIPU vs DIGU) and single arm case series (>20 cases) of DIGU were eligible for inclusion. Secondary hypospadias, two-stage repairs, disorders of sex development, significant curvature of >30°, and a mean or median follow-up of less than 12 months were excluded.

Discussion: A total of 499 articles were screened and 14 studies (3 RCTs, 5 non-randomized studies (NRSs), and 6 case series) with a total of 1753 children (distal: 1334 (76%) and proximal: 419 (24%)) were found eligible. Mean follow-up of the studies was between 16 and 77 months. DIGU was found superior to TIPU in decreasing meatal/neourethral stenosis (p = 0.02, 95% CI 0.02-0.78). All other parameters were found comparable including overall complications, fistula and glans dehiscence rates. Success rates were similar among the groups ranging between 48% and 96% for DIGU and 43-96% in the TIPU group. The lack of standardization in the definition of complications and success was the major limitation of this study.

Conclusions: Using an inlay graft during primary hypospadias repair decreases the risk of meatal/neourethral stenosis. However, current evidence does not demonstrate superiority of DIGU over TIPU in terms of treatment success and overall complication rates.

Keywords: Graft; Hypospadias; Inlay; Pediatrics.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Child
Humans
Hypospadias* / surgery
Infant
Male
Plastic Surgery Procedures*
Surgical Flaps
Treatment Outcome
Urethra / surgery
Urologic Surgical Procedures, Male