Abstract
We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair. A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected. A meta-analysis of studies comparing PR vs. circumcision was performed for the outcomes "hypospadias fistula formation" and "reoperation rate." Twenty studies were identified. Nineteen reported the outcome of PR in 2115 patients. Overall, 95% (2016/2115) of patients undergoing PR had distal hypospadias. The cumulative rate of PR complications was 7.7% (163/2115 patients), including 5.7% (121/2115 patients) preputial dehiscences and 1.5% (35/2117 reported patients) secondary phimoses needing circumcision. A meta-analysis of seven studies comparing patients undergoing PR vs. circumcision showed no increased risk of urethral fistula formation associated with PR, odds ratio (OR) (Mantel-Haenszel, Fixed effect, 95% CI), 1.25 (0.80-1.97). Likewise, two studies comparing the overall reoperation rate did not show an increased risk of reoperation associated with PR, OR (Mantel-Haenszel, Random effect, 95% CI), 1.27 (0.45-3.58). PR carries an 8% risk of specific complications (dehiscence of reconstructed prepuce or secondary phimosis needing circumcision), but does not seem to increase the risk of urethroplasty complications, and the overall reoperation rate of hypospadias repair.
Highlights
Preputial asymmetry is one of the components of hypospadias
The range of reported rates of specific preputial complications after Preputial reconstruction (PR) is wide, with rates being completely negligible in some series (2), and it is unclear whether the arguments concerning the association between PR and urethroplasty complications are based on evidence or merely theoretical
PR was generally performed in association with a tubularized incised plate urethroplasty (TIPU), a Mathieu flip-flap urethroplasty, or some kind of glanuloplasty
Summary
Preputial asymmetry is one of the components of hypospadias. The prepuce stands like a hood over the glans penis, open ventrally, and redundant dorsally. Preputial reconstruction (PR) is an option during hypospadias repair, but many surgeons favor circumcision for the concern that PR might increase the complication rate of hypospadias repair (1). PR might do so because it carries specific complications, namely, dehiscence of the reconstructed prepuce and secondary phimosis, but the concern exists that it might jeopardize the urethroplasty thereby increasing the risk of fistula formation (1). We performed a systematic review of the literature on PR during hypospadias repair to determine the cumulative risk of specific complications related to the procedure. We performed a meta-analysis of studies comparing urethroplasty complications and reoperation rates in patients undergoing hypospadias repair associated with PR vs circumcision to test the hypothesis that circumcision is associated with a lower rate of complications related to the urethroplasty, namely, fistula rate, and a lower reoperation rate
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