Reconstructive Techniques of Primary Distal Penile Hypospadias: A Meta-Analysis Study of Last 10 Years

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Omar Goda Hassan Mohammad ◽  
Khaled Ahmed Mahmoud Reyad ◽  
Ahmed Ali Hassan ◽  
Osama Fouad Mohamed Abdelgawad
Keyword(s):  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Hypospadias Repair ◽  
Inclusion Criteria ◽  
Meatal Stenosis ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Reported Data ◽  
Reconstructive Techniques

Abstract Background Hypospadias is one of the most common congenital anomalies affecting males worldwide, with distal variants representing up to 70% of all cases. Several surgical techniques are adopted for distal hypospadias repair. However, there is still much controversy about the ideal technique. Objectives The aim of this study is to compare between the most popular reconstructive techniques for distal penile hypospadias repair. Highlighting their effectiveness, in term of success rate as well as the risk of postoperative complications. Methods For this systematic review, PubMed/Medline and ScinceDirect online databases were searched using the keywords ‘distal hypospadias, complications and outcome’. Inclusion criteria were primary repairs; distal hypospadias; pediatric case series and standard techniques. Abstracts of articles identified were reviewed, and then relevant articles were retrieved in full. Papers were only included if data on at least one of the main outcome measures was obtainable, which are postoperative fistula, meatal stenosis and glanular dehiscence. Data were pooled using CMA software, effect sizes were reported as event rates with 95% confidence intervals (CI) been calculated for each outcome. Results A total of 25 studies, which included 4572 patients, met the inclusion criteria. The tubularised incised plate (TIP) was the most commonly adopted procedure followed by the peri-meatal flap (Mathieu). Few studies reported data for other techniques like onlay flap, Thiersch-Duplay, meatal advancement and MAGPI procedures, in addition to urethral mobilization technique. The overall incidence of main complications was 10.5% with comparable results among different techniques. The results are in favor of urethral mobilization and TIP procedures over Mathieu regarding the incidence of both meatal stenosis and post-operative fistula. Overall, the quality of the included studies was determined to be satisfactory. Conclusion Compared with Mathieu technique, urethral mobilization and the TIP procedure for distal penile hypospadias (DPH) reconstruction were associated with a lower risk of overall complications specifically postoperative fistula and meatal stenosis.

scholarly journals A Meta-analysis of Major Complications between Traditional Pacemakers and Leadless Pacemakers

2020 ◽  
Author(s):  
Yun-Qing Chen
Keyword(s):  
Pericardial Effusion ◽  
Risk Ratio ◽  
Clinical Effect ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Inclusion Criteria ◽  
Cardiac Perforation ◽  
Major Complications ◽  
Central Register ◽  
Reported Data

Objectives: We aim to compare the major complications between leadless pacemakers and traditional pacemakers.Background: Leadless pacemakers, which are increasingly used in clinical practice, have several advantages compared with traditional pacemakers in avoiding pocket- and lead-related complications. However, the clinical effect of leadless pacemakers remains controversial.Methods: PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the CNKI database, and the Wanfang database were searched from July 2013 to December 2019. Studies comparing leadless pacemakers and traditional pacemakers were included. The primary end point was major complications. The secondary end points were cardiac perforation/pericardial effusion, device revision or extraction, loss of device function, and death.Results: Six studies fulfilled the inclusion criteria. Only four of the six studies reported data on major complications.Leadless pacemakers were associated with a lower incidence of major complications (risk ratio 0.33, 95% confidenceinterval 0.25–0.44, P < 0.00001, I² = 49%). We extracted data on cardiac perforation/pericardial effusion, device revisionor extraction, loss of device function, and death from six studies. Our meta-analysis showed that leadless pacemakershave a higher risk of cardiac perforation or pericardial effusion (risk ratio 4.28, 95% confidence interval 1.66–11.08,P = 0.003, I² = 0%). No statistically significant differences were found for mortality, device revision or extraction, andloss of device function.Conclusion: Compared with traditional pacemakers, leadless pacemakers have a significantly decreased risk of majorcomplications, but have a higher risk of cardiac perforation or pericardial effusion.

scholarly journals Postoperative outcomes in distal hypospadias: a meta-analysis of the Mathieu and tubularized incised plate repair methods for development of urethrocutaneous fistula and urethral stricture

2019 ◽  
Vol 35 (11) ◽  
pp. 1301-1308 ◽  
Author(s):  
Hans Winberg ◽  
Einar Arnbjörnsson ◽  
Magnus Anderberg ◽  
Pernilla Stenström
Keyword(s):  
Urethral Stricture ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Urethrocutaneous Fistula ◽  
Levels Of Evidence ◽  
Tubularized Incised Plate ◽  
Postoperative Fistula ◽  
Distal Hypospadias ◽  
Based Medicine

Abstract Purpose To compare the two major complications, namely postoperative urethrocutaneous fistula and urethral stricture, between the Mathieu and tubularized incised plate (TIP) repair methods for distal hypospadias. Methods In this meta-analysis, electronic databases were searched for comparative studies on the two techniques. The Oxford Centre for Evidence-based Medicine Levels of Evidence was used to evaluate the included studies. The main outcome measure was the frequency of postoperative fistula and urethral stricture. RevMan 5.3 was used for statistical analyses, with P < 0.05 indicating statistical significance. Results A total of 17 studies, which included 1572 patients, met the inclusion criteria. The frequency of urethrocutaneous fistula did not differ between the Mathieu [115 (13%)] and TIP [90 (13%)] methods [odds ratio (OR) 1.1, 95% confidence intervals (CI) 0.6–1.9; P = 0.73)]. Urethral stricture was less frequent after the Mathieu [15 (2%)] method than after the TIP [37 (5%)] method (OR 0.5, 95% CI 0.3–0.8; P < 0.01), even after the subgroup analysis of eight randomized controlled trials was included. Overall, the quality of the included studies was determined to be satisfactory. The levels of evidence on which this review was based ranged from 1b to 2b using the CEBM Levels of Evidence. Conclusion Compared with TIP repair, Mathieu repair for hypospadias had a significantly lower risk for urethral stricture; however, the risk for urethrocutaneous fistula was similar.

Response to “Re: Non-stented versus stented urethroplasty for distal hypospadias repair: A systematic review and meta-analysis”

2018 ◽  
Vol 14 (3) ◽  
pp. 221
Author(s):  
Michael Chua ◽  
Christopher Welsh ◽  
Bisma Amir ◽  
Jan Michael Silangcruz ◽  
Jessica Ming ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Hypospadias Repair ◽  
Distal Hypospadias

scholarly journals Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

2015 ◽  
Vol 39 (4) ◽  
pp. E6 ◽  
Author(s):  
Michael F. Shriver ◽  
Jack J. Xie ◽  
Erik Y. Tye ◽  
Benjamin P. Rosenbaum ◽  
Varun R. Kshettry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nerve Root ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Wound Complications ◽  
Complication Rates ◽  
Nerve Root Injury ◽  
Lumbar Microdiscectomy ◽  
Root Injury

OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

scholarly journals Can early cranioplasty reduce the incidence of hydrocephalus after decompressive craniectomy? A meta-analysis

2020 ◽  
Vol 11 ◽  
pp. 94 ◽  
Author(s):  
Davide Nasi ◽  
Mauro Dobran
Keyword(s):  
Decompressive Craniectomy ◽  
Lower Incidence ◽  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Cerebrospinal Fluid Dynamics ◽  
Inclusion Criteria ◽  
Postoperative Hydrocephalus ◽  
Meta Analyses ◽  
Early Cranioplasty

Background: Do alterations of cerebrospinal fluid dynamics secondary to decompressive craniectomy (DC) lead to hydrocephalus, and can this effect be mitigated by early cranioplasty (CP)? In this meta-analysis, we evaluated whether the timing of CP decreased the incidence of postoperative hydrocephalus. Methods: We performed a systematic search of PubMed/MEDLINE, Scopus, and the Cochrane databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for English language articles (1990–2020). We included case series, case–control, and cohort studies, and clinical trials assessing the incidence of hydrocephalus in adult patients undergoing early CP (within 3 months) versus late CP (after 3 months) after DC. Results: Eleven studies matched the inclusion criteria. The rate of postoperative hydrocephalus was not significantly different between the early (=96/1063; 9.03%) and late CP (=65/966; 6.72%) group (P = 0.09). Only in the three studies specifically reporting on the rate of hydrocephalus after DC performed to address traumatic brain injury (TBI) alone was there a significantly lower incidence of hydrocephalus with early CP (P = 0.01). Conclusion: Early CP (within 90 days) after DC performed in TBI patients alone was associated with a lower incidence of hydrocephalus. However, this finding was not corroborated in the remaining eight studies involving CP for pathology exclusive of TBI.

Effects of CYP2C8 and SLCO1B1 Genetic Polymorphisms on Repaglinide Pharmacokinetics: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 20 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Shuang Zhou ◽  
Qian Xiang ◽  
Guangyan Mu ◽  
Lingyue Ma ◽  
Shuqing Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Glucose ◽  
Genetic Polymorphisms ◽  
Blood Glucose Concentration ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Current Systematic Review ◽  
Potential Impact ◽  
Reported Data ◽  
Insufficient Number

Objective: The purpose of this systematic review and meta-analysis was to summarize the potential impact of CYP2C8 and SLCO1B1 genetic polymorphisms on repaglinide pharmacokinetics. Methods: A systematic search was conducted using electronic databases. Eligible studies reported data from pharmacokinetic evaluations of repaglinide in healthy adults according to different categories of CYP2C8 and SLCO1B1 genetic polymorphisms. Results: Six studies including a total of 191 participants met the inclusion criteria. We noted that CYP2C8 *1/*3 carriers exhibited lower AUC(0-∞) (SMD: -0.77; 95%CI: -1.23 to -0.30; P=0.001) and Cmax (SMD: -0.94; 95%CI: - 1.41 to -0.47; P<0.001) than CYP2C8 *1/*1 carriers. There were no significant differences in AUC(0-∞), Cmax, t1/2 and mean change in blood glucose concentration between *1/*4 and *1/*1 carriers. Further, *3/*3 carriers had lower Cmax (SMD: -1.42; 95%CI: -2.66 to -0.17; P=0.026) than *1/*1 carriers. Additionally, *3/*3 carriers had lower Cmax than *1/*3 carriers (SMD: -1.20; 95%CI: -2.40 to -0.00; P=0.050). Finally, we noted that repaglinide pharmacokinetics did not differ by SLCO1B1 genotype. Conclusion: The current systematic review and meta-analysis indicated that the genotype of CYP2C8, but not SLCO1B1, may affect repaglinide pharmacokinetics. However, because of the comparatively insufficient number of published studies included, our conclusions require support from additional studies.

Non-stented versus stented urethroplasty for distal hypospadias repair: A systematic review and meta-analysis

2018 ◽  
Vol 14 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Michael Chua ◽  
Christopher Welsh ◽  
Bisma Amir ◽  
Jan Michael Silangcruz ◽  
Jessica Ming ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Hypospadias Repair ◽  
Distal Hypospadias

Four petal evisceration versus standard technique: A retrospective study

2020 ◽  
pp. 112067212095016
Author(s):  
Stefano Ranno ◽  
Massimiliano Serafino ◽  
Paolo Nucci
Keyword(s):  
Surgical Techniques ◽  
Case Series ◽  
Standard Technique ◽  
Complication Rates ◽  
Inclusion Criteria ◽  
Implant Exposure ◽  
Case Series Study ◽  
Series Study ◽  
Low Rate

Purpose: To compare the four-petal evisceration technique and the standard evisceration technique. Methods: In this retrospective, comparative case series study, sixteen charts of patients fulfilled the inclusion criteria and were were reviewed. Orbital implant exposition and complication rates between the two surgical techniques were evaluated. Results: A total of 16 eye of 16 patients fulfilled the inclusion criteria and were included in the analysis (eight in the four petal group and eight in the standard evisceration group). During postoperative follow-up there were no cases of implant exposure or migration in the four-petal group and two cases (25%) of implant exposure in the standard evisceration group. Exposed orbital implants dimension were both 16 mm and patients eviscerated for phtisis bulbi All surgeries were uneventful, and there were no serious complications during the study. Conclusion: Four petal evisceration technique seems particularly useful in patients with phtisis bulbi because it allowed the placement of an implant significantly larger than the standard technique with low rate of esposition.

scholarly journals LIMITED URETHERAL MOBILIZATION PROCEDURE (LUMP) FOR DISTAL PENILE HYPOSPADIAS REPAIR, A SINGLE CENTRE RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 9 (5) ◽  
pp. 1335-1343
Author(s):  
Muhammad Riaz-ul-Haq ◽  
◽  
Arslan Raza Wasati ◽  
Mazhar Rafi ◽  
Sohail Jamil ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Surgical Techniques ◽  
Operation Time ◽  
Postoperative Management ◽  
Fistula Formation ◽  
Paediatric Surgery ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Meatal Stenosis ◽  
Cosmetic Appearance

Background: Distal penile hypospadias is one of the commonest varieties of hypospadias. Different techniques have been mentioned in literature. The success rate is usually assessed by rate of fistula formation and over all cosmetic appearance and functional outcome. Limited Uretheral Mobilization Procedure (LUMP) for distal penile hypospadias is considered a good technique with almost zero fistula rate in some series. As no new urethral tube is constructed there is no risk of fistula. Objective: To evaluate the results of the Limited Urethral Mobilization Procedure (LUMP) for distal hypospadias repair. Methods.It is retrospective analysis of 32 patients aged up to 12 years who were treated with Limited urethral mobilization procedure for distal penile hypospadias in the Department of Paediatric Surgery Jinnah Hospital Lahore from December 2018 to November 2019. All patients were operated under general anesthesia. The urethra proximal to the meatus was mobilized adequately in such a way that it should reach the tip of glans easily without any ventral bending of penis.Then the urethra was placed in the glandular wings and reconstruction of glans was carried out. Dartos flap was also placed to cover the urethra as a safety measure to avoid urethrocutaneous fistula formation. Follow up was done for a period of 3 months with respect to fistula formation, meatal stenosis, retraction , chordee and over all cosmetic appearance. Results: Age range of children was 9 months to 12 years. Operation time ranged from 60-80 minutes. Seven of 32 cases were previously operated for distal penile hypospadias but after disruption of repair meatus was lying at coronal or subcoronal level. They also underwent LUMP. Five cases had minor chordee, it was corrected at the time of uretheral mobilization by simple excision of fiberous tisse in 4 patients while modified Nesbit dorsal placation was done in one. Cosmetically normal looking circumcised penis with slit like meatus was achieved in all.Two cases got superficial wound infection, two had meatal stenosis, one meatal retraction, one ventral chordee and one urethrocutaneous fistula. Conclusion: LUMP for distal penile hypospadias is a simple and effective procedure with minimum complications.There is no chance for development of urethrocutaneous fistula, a major postoperative complication of other surgical techniques for uretheroplasty. Postoperative management is simple and hospital stay is short.

scholarly journals URETHROPLASTY

2006 ◽  
Vol 13 (04) ◽  
pp. 615-620
Author(s):  
MUHAMMAD AKMAL ◽  
SAFDAR HASSAN JAVED SIAL ◽  
MUHAMMAD HUSSAIN WASEER
Keyword(s):  
Randomized Study ◽  
Prospective Randomized Study ◽  
Hypospadias Repair ◽  
Meatal Stenosis ◽  
Hematoma Formation ◽  
Tubularized Incised Plate ◽  
Distal Hypospadias ◽  
Treat All ◽  
Causes Of Failure

Objectives: To assess the results of Tubularized incised plate urethroplastyfor hypopadias repair and to find out the causes of failure. Design: Prospective randomized study. Place & Durationof Study: Department of urology, Allied Hospital Faisalabad. From May 2001 to April 2003. Patients & Methods: 20consecutive patients of Hypospadias were included in this study. All cases were managed by Tabularized incised platUrethroplasty (TIPU). Results: 12 cases presented with distal Hypospadias. 08 patients came with proximalHypospadias. Common age at presentation was below 5 years. Orthoplasty was done by Nasbit technique in 04patients. Overall success of tabularized incised plate urethroplasty for distal Hypospadias repair was seen in10(83.60%) cases. 01(8.30%) patients developed fistula and 01(8.30%) patient presented with total disruption. Meatalstenosis was observed in 01(8.30%) patient which responded well to regular dilatation. Overall success of TIPU forproximal Hypospadias repair was seen in 05(62.50%) patients. Fistula occurred in 02(25%) patients and total disruptionin 01(12.5%) patient. 01(12.5%) patient developed meatal stenosis which was managed by regular dilatation.Conclusion: TIPU can be applied as a valid option to treat all types of Hypospadias. Most of the complications canbe minimized by proper technique, prevention of hematoma formation and infection.

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