Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review

European Urology
Omar FahmyGeorgios Gakis

Abstract

Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported. To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence. We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula. A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among patients with fistula after ...Continue Reading

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Citations

Mar 8, 2016·European Urology·Bruce J Schlomer, Allen F Morey
Feb 17, 2017·International Journal of Urology : Official Journal of the Japanese Urological Association·Omar FahmyGeorgios Gakis
Feb 6, 2019·International Journal of Urology : Official Journal of the Japanese Urological Association·Abdelaziz Yehya MahmoudMohamed A Baky Fahmy
Jul 11, 2020·International Braz J Urol : Official Journal of the Brazilian Society of Urology·Wenwen HanYanfang Yang
Apr 17, 2020·Frontiers in Pediatrics·Shou Xing DuanShu Hua Ma
May 21, 2020·International Journal of Urology : Official Journal of the Japanese Urological Association·Mohammadreza RazzaghiBabak Javanmard
May 3, 2018·International Journal of Urology : Official Journal of the Japanese Urological Association·Wei RuYiding Shen
Jul 22, 2020·International Journal of Impotence Research·Nicolaas LumenPiet Hoebeke

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