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Comparison of the efficacy and safety of dorsal inlay graft urethroplasty (DIGU) method with tubularized incised plate urethroplasty (TIPU) method in primary distal hypospadias repair: a systematic review and meta-analysis



Abstract

Link of Video Abstract: https://youtu.be/r399GEt3guo

Introduction: Tubularized Incised Plate Urethroplasty (TIPU) is a technique that is widely used in distal hypospadias repair. The advantages possessed by this technique are better cosmetics, the meatus is at the tip of the penis, and the phallus is straight. Some researchers believe that a urethral plate with a size of less than 8 mm is unsuitable for the TIPU technique so augmentation with a graft using the dorsal inlay graft urethroplasty (DIGU) technique is needed. To date, there have been no systematic reviews and meta-analyses that have directly compared the efficacy and complications of DIGU and TIPU. Therefore, this study aimed to compare the effectiveness and complications of these two modalities for repair in primary distal hypospadias patients.

Methods: This study is a systematic review study and meta-analysis. The protocol for conducting and compiling this study was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was performed on six databases: PubMed, Scopus, Web of Science, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. The risk of bias in the study will be analyzed using the Cochrane Risk of Bias Tools for Randomized Trials version 2 (RoB 2).

Results: Six studies that met the inclusion criteria were included in the meta-analysis with a total of 381 samples. The success rates (OR 1.46, 95% CI 0.74-2.87, p = 0.28) and urine output (OR 2.54, 95% CI 0.63-10.20, p = 0.19) were not significantly different, while the mean operating time (MOT) (SMD 1.96, 95% CI 1.10-2.82, p < 0.0001) was significantly shorter in TIPU (P < 0.05). The incidence of meatal stenosis was significantly more in TIPU than DIGU significantly (OR 5.11, 95% CI 1.46-17.92, p = 0.01), while fistula (OR 2.93, 95% CI 0.92-9.35, p = 0.07) and dehiscence (OR 3.05, 95% CI 0.81-11.45, p = 0.10) was not significantly different between the two techniques.

Conclusion: TIPU has the advantage of shorter operating time but a higher incidence of meatal stenosis than DIGU.

Keywords: tubularized incised plate urethroplasty dorsal inlay graft urethroplasty primary distal hypospadias

References

  1. Snodgrass WT. Consultation with the Specialist: Hypospadias. Pediatr Rev. 2004;25(2):63–7. Available from: http://dx.doi.org/10.1542/pir.25-2-63
  2. Snodgrass WT. Hypospadias [Internet]. Campbell-Walsh Urology. Elsevier; 2012. p. 3503-3536.e5. Available from: http://dx.doi.org/10.1016/b978-1-4160-6911-9.00130-4
  3. Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying Hypospadias. Sex Dev. 2015/11/28. 2015;9(5):239–59. Available from: https://pubmed.ncbi.nlm.nih.gov/26613581
  4. Keays MA, Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11(1-2Suppl1):S48–53. Available from: https://pubmed.ncbi.nlm.nih.gov/28265319
  5. Nurhadi P, Adhi Saputra RA. Profile of hypospadias patients at Saiful Anwar General Hospital Malang. Pan Afr Med J. 2018;31. Available from: http://dx.doi.org/10.11604/pamj.supp.2018.31.1.15598
  6. Jawale SA. Ten Commandments of Hypospadias Surgery. J Pediatr & Neonatal Care. 2017;6(6). Available from: http://dx.doi.org/10.15406/jpnc.2017.06.00268
  7. Snodgrass W. Tubularized, Incised Plate Urethroplasty for Distal Hypospadias. J Urol. 1994;151(2):464–5. Available from: http://dx.doi.org/10.1016/s0022-5347(17)34991-1
  8. Eldeeb M, Nagla S, Abou-Farha M, Hassan A. Snodgrass vs Snodgraft operation to repair the distal hypospadias in the narrow urethral plate. J Pediatr Urol. 2020;16(2):165.e1-165.e8. Available from: http://dx.doi.org/10.1016/j.jpurol.2020.01.006
  9. Ahmed Medhat Zaki WOZ, Ehab Abd El Aziz El Shafei OA-EA-N, Mohamed MA-S. Snodgraft Versus Snodgrass Repair of Primary Distal Hypospadias: A Comparative Study. Int J Curr Microbiol Appl Sci. 2021;10(5):512–23. Available from: http://dx.doi.org/10.20546/ijcmas.2021.1005.059
  10. Hadidi AT. Hypospadias Surgery [Internet]. Springer International Publishing; 2022. Available from: http://dx.doi.org/10.1007/978-3-030-94248-9
  11. Holland AJA, Smith GHH. Effect Of The Depth And Width Of The Urethral Plate On Tubularized Incised Plate Urethroplasty. J Urol. 2000;164(2):489–91. Available from: http://dx.doi.org/10.1016/s0022-5347(05)67408-3
  12. Sarhan O, Saad M, Helmy T, Hafez A. Effect of Suturing Technique and Urethral Plate Characteristics on Complication Rate Following Hypospadias Repair: A Prospective Randomized Study. J Urol. 2009;182(2):682–6. Available from: http://dx.doi.org/10.1016/j.juro.2009.04.034
  13. Ferro F, Vallasciani S, Borsellino A, Atzori P, Martini L. Snodgrass Urethroplasty: Grafting the Incised Plate—10 Years Later. J Urol. 2009;182(4S):1730–5. Available from: http://dx.doi.org/10.1016/j.juro.2009.03.066
  14. Mouravas V, Filippopoulos A, Sfoungaris D. Urethral plate grafting improves the results of tubularized incised plate urethroplasty in primary hypospadias. J Pediatr Urol. 2014;10(3):463–8. Available from: http://dx.doi.org/10.1016/j.jpurol.2013.11.012
  15. Laura SF, Duarsa GWK, Mahadewa TG. Correlation Of Cystostomy To Low Urethrocutaneous Fistula Incident In Hypospadia Surgery. Bali Medical Journal. 2014;3(3):125–128. https://doi.org/10.15562/bmj.v3i3.88
  16. Ahmed S, Noureldin YA, Sherif H, Zahran A, Omar R. Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair. African J Urol. 2021;27(1). Available from: http://dx.doi.org/10.1186/s12301-021-00255-6
  17. Hadidi AT. Hypospadias Fistula [Internet]. Hypospadias Surgery. Springer International Publishing; 2022. p. 799–811. Available from: http://dx.doi.org/10.1007/978-3-030-94248-9_60
  18. Cakan M, Yalçinkaya F, Demirel F, Aldemir M, Altuğ U. The midterm success rates of tubularized incised plate urethroplasty in reoperative patients with distal or mid penile hypospadias. Pediatr Surg Int. 2005;21(12):973-6. Available from: doi: 10.1007/s00383-005-1555-x.
  19. Omran F, Kyrou I, Osman F, Lim VG, Randeva HS, Chatha K. Cardiovascular Biomarkers: Lessons of the Past and Prospects for the Future. Int J Mol Sci. 2022;23(10):5680. Available from: https://pubmed.ncbi.nlm.nih.gov/35628490
  20. Pfistermuller KL, McArdle AJ, Cuckow PM. Meta-analysis of complication rates of the tubularized incised plate (TIP) repair. J Pediatr Urol. 2015;11(2):54-9. Available from: doi: 10.1016/j.jpurol.2014.12.006.
  21. Helmy TE, Ghanem W, Orban H, Omar H, El-Kenawy M, Hafez AT, et al. Does grafted tubularized incided plate improve the outcome after repair of primary distal hypospadias: A prospective randomized study? J Pediatr Surg. 2018;53(8):1461–3. Available from: http://dx.doi.org/10.1016/j.jpedsurg.2018.03.019
  22. Zeina WO, Zaki AM, El Shafei EA, Al-Najjar OAE, Mohamed MAS. Snodgraft Versus Snodgrass Repair of Primary Distal Hypospadias: A Comparative Study. Int J Curr Microbiol Appl Sci. 2021;10:512–523
  23. Snodgrass W, Cost N, Nakonezny PA, Bush N. Analysis of Risk Factors for Glans Dehiscence After Tubularized Incised Plate Hypospadias Repair. J Urol. 2011;185(5):1845–51. Available from: http://dx.doi.org/10.1016/j.juro.2010.12.070
  24. El Shazly AM, Sherif HW, Mohammed SA, Omar RG. Classic Snodgrass Versus Inner Preputial Inlay Grafted Snodgrass in Distal Penile Hypospadias Repair. Benha J Appl Sci. 2020;5(1):1–6. Available from: http://dx.doi.org/10.21608/bjas.2020.135005
  25. Güler Y. TIPU outcomes for hypospadias treatment and predictive factors causing urethrocutaneous fistula and external urethral meatus stenosis in TIPU: Clinical study. Andrologia. 2020;52(9). Available from: http://dx.doi.org/10.1111/and.13668
  26. Abdurrahman A, Hutahean AYA. The learning curve in hypospadias urethroplasty: single-surgeon experience. Bali Med J. 2020;9(1):408–12. Available from: http://dx.doi.org/10.15562/bmj.v9i1.1747

How to Cite

Fauzan, A., Hidayatullah, F. ., Salsabila, S. ., Setiawan, M. R. ., Fitriani, R. ., Rizkyansyah, H. F. ., Yatindra, I. B. G. T. Y. ., Renaldo, J. ., & Djojodimedjo , T. (2023). Comparison of the efficacy and safety of dorsal inlay graft urethroplasty (DIGU) method with tubularized incised plate urethroplasty (TIPU) method in primary distal hypospadias repair: a systematic review and meta-analysis. Bali Medical Journal, 12(2), 2251–2257. https://doi.org/10.15562/bmj.v12i2.4612
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Ahmad Fauzan
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Furqan Hidayatullah
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Sirin Salsabila
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Muhammad Rifki Setiawan
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