The Comparison on Complications from Suprapubic vs. Transurethral Urinary Diversion After Hypospadias Repair: Meta-Analysis

Abstract

Background: Urinary diversion post hypospadias repair plays an important role in the prevention of complications. This study objective was to analyze the comparison among suprapubic versus transurethral urinary diversion in preventing the complications after hypospadias repair. We aimed to compare the complications from suprapubic urinary diversion and transurethral urinary diversion in patients after hypospadias repair. Methods: A systematic search was conducted in PUBMED and Google Scholar databases to identify relevant randomized controlled trials (RCTs). The subjects were studies that involved post-operative hypospadias patients. Compared outcomes were the incidence of urethrocutaneous fistula, meatal stenosis, and repair disruption. The approach to systematic study began with the use of PRISMA protocol based on inclusion and exclusion criteria. Meta-analysis was performed based on pooled analysis. Visualizations of each study were described with forest plots. Results: There were two RCTs that met the criteria for quantitative analysis. Forest plot analysis showed the use of suprapubic diversion might significantly lower the risk of urethrocutaneous fistula (OR 0.22, 95% CI 0.05 - 0.89, p = 0.03). Meatal stenosis and repair disruption between the two studies did not differ significantly. Conclusion: There was a significantly lower incidence of urethrocutaneous fistula in postoperative hypospadias patients who performed suprapubic urine diversion compared to those who received transurethral urine diversion. The difference in the incidence of meatal stenosis and repair disruption was insignificant between the two groups of urine diversion.