Outcomes in distal hypospadias: A systematic review of the Mathieu and tubularized incised plate repairs
Outcomes in distal hypospadias: A systematic review of the Mathieu and tubularized incised plate repairs
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DOI：
10.1016/j.jpurol.2010.11.008
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发表时间：
2012-06-01
影响因子：
2
通讯作者：
Kenny, Simon E.
中科院分区：
文献类型：
--
作者：
Wilkinson, David J.;Farrelly, Paul;Kenny, Simon E.
目的：比较使用管状切开钢板（TIP）和Mathieu技术进行远端尿道下裂手术后的并发症发生率。方法：对于本荟萃分析，使用关键词“尿道下裂”检索Medline（1990-2009）、Embase（1990-2009）和科克伦数据库。入选标准为：（一）基本修复; ii）远端尿道下裂; iii）儿科个案系列; iv）标准Mathieu和TIP技术; v）可从论文中获得的并发症数据。如果在论文中明确识别，则仅将病例纳入每种并发症的分母中。主要结果：共纳入129篇文献进行全面分析，其中23篇符合纳入标准，TIP修复1872例，Mathieu修复1496例。我们发现Mathieu技术的尿道瘘发生率增加（3.8% vs 5.3%，P = 0.028）;然而，亚组分析中丢失了这一点。TIP组尿道口狭窄发生率明显高于TIP组（3.1%比0.7%，P < 0.001）。Mathieu和TIP技术的术后并发症发生率均较低。由于报告并发症和随访缺乏一致性，系列之间的比较很困难。我们提倡尿道下裂的报告结果的统一标准。(C)2010年儿科泌尿学杂志公司。由爱思唯尔有限公司出版。保留所有权利。
Aim: To compare complication rates after distal hypospadias surgery using the tubularized incised plate (TIP) and Mathieu techniques.Methods: For this meta-analysis, the Medline (1990-2009), Embase (1990-2009) and Cochrane databases were searched using the keyword 'hypospadias'. Inclusion criteria were: i) primary repairs; ii) distal hypospadias; iii) paediatric case series; iv) standard Mathieu and TIP techniques; v) complication data obtainable from the paper. Cases were only included in the denominator for each complication if explicitly identified in the paper. Fisher's exact was used for statistical analysis, with P < 0.05 considered significant.Main results: 129 papers were selected for full analysis; 23 papers met the inclusion criteria comprising 1872 TIP repairs and 1496 Mathieu repairs. We identified an increased incidence of urethral fistulae with the Mathieu technique (3.8% vs 5.3%, P = 0.028); however, this is lost on subgroup analysis. An increased incidence of meatal stenosis was identified in the TIP group (3.1% vs 0.7%, P < 0.001).Conclusions: There is no clear consensus on the ideal method of repair for distal hypospadias. Both the Mathieu and TIP techniques have been shown to have low rates of postoperative complications. Comparison between series is difficult because of a lack of consistency in reporting complications and follow up. We advocate uniform standards for reporting outcomes of hypospadias. (C) 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.