A meta-analysis: single or double dartos flap layer in tubularized incised plate urethroplasty to prevent urethrocutaneous fistula?

Abstract

BackgroundsUrethrocutaneous fistula is one of the most common complications after urethroplasty. This meta-analysis aims to evaluate the superiority of double dartos flap to single dartos flap in preventing fistula during tubularized incised plate urethroplasty (TIPU), which is one of the most frequently used operations for hypospadias.MethodsWe extracted clinical trials under the following included criteria: (1) children with TIPU; (2) a comparison of single and double flap layer; and (3) record of complications with the following excluded criteria: (1) non-comparison and (2) lack of data. Finally, 13 studies from PubMed, Cochrane Library, Scopus, and Embase have been investigated, with a total of 1,185 patients from 2005 to 2022. The quality assessment was conducted according to the Cochrane handbook and the Newcastle–Ottawa scale. A mixed-effect model was utilized to weigh the risk of fistula, phallic rotation, meatal stenosis, and wound dehiscence by the Review Manager V.5.4 software.ResultsThe double dartos flap layer group excels in descending the risk of postoperative fistula [odds ratio (OR) = 9.56; 95% confidence interval (CI) (4.76, 19.22); P < 0.00001] and phallic rotation [OR = 31.26; 95% CI (9.60, 101.84); P < 0.00001], while there are no differences in the rate of meatal stenosis [OR = 1.49; 95% CI (0.73, 2.70); P = 0.31] and wound dehiscence [OR = 2.30; 95% CI (0.80, 6.63); P = 0.12].ConclusionsThe routine utility of a double dartos flap layer is recommended as a potential treatment during the tubularized incised plate urethroplasty.Systematic Review Registrationidentifier PROSPERO CRD42022366294.

Single dartos flap versus double dartos flap in hypospadias repair: A systematic review and meta-analysis with trial sequential analysis and fragility index

“…Reduced incidence of UCF in the DDF group can be explained based on assumption of robustness of the intermediate layer in DDF and improved vascularity promoting healing but decreased incidence of meatal stenosis is not explainable based on the above assumption. Our findings of decreased incidence of UCF in DDF are consistent with the many comparative studies, RCTs and recently published SRMA by Yuan et al 27 As we have used all RCTs for our meta-analysis, the statistically significant result has upgraded level of evidence from 1b to 1a as per hierarchy of the level of evidence for therapy. While examining the TSA findings, it was observed that the Z curve crosses both conventional and trial sequential boundaries just before reaching the RIS.…”