Frontiers in endocrinology · 2026
Network meta-analysis of different preoperative hormone therapies for improving postoperative complications in pediatric hypospadias.
СтатьяNetwork Meta-AnalysisСистематический обзорНазвание и аннотация: Перевод в очереди
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Wu Ling, Wang Wenmei, Zhao Qi, Liu Xing, Pan Yun, Yang Bowen, Xiong Quanqing, Deng Hongqiang, Chen Jiabo
Аннотация
OBJECTIVE: To evaluate and compare the efficacy of different preoperative hormonal therapies for preventing postoperative complications after hypospadias repair in pediatric patients through a systematic review and network meta-analysis.
METHODS: PubMed, Web of Science, Cochrane Library, and CNKI were systematically searched (inception to March 15, 2026). Randomized controlled trials (RCTs) enrolling pediatric patients with hypospadias who received preoperative hormone therapy were included. Risk of bias was assessed using the Cochrane RoB 2 tool. The primary outcomes were postoperative urethrocutaneous fistula, glans dehiscence, and meatal stenosis. Bayesian network meta-analysis was performed using the gemtc package in R 4.3.1, and SUCRA was used to rank intervention efficacy. Sensitivity analysis excluding non-distal cohorts was performed to assess robustness.
RESULTS: Six RCTs (715 patients) were included. Direct pairwise meta-analysis showed that androgen therapy reduced the odds of urethrocutaneous fistula (pooled OR = 0.474; 95% CI: 0.241-0.934; P = 0.031). In the sensitivity analysis restricted to distal hypospadias only, the protective trend persisted but did not reach statistical significance (OR = 0.613; 95% CI: 0.285-1.319). No significant benefit of androgen was observed for glans dehiscence or meatal stenosis. Estrogen did not significantly reduce any complication. SUCRA analysis identified androgen as the most probable effective intervention for fistula prevention.
CONCLUSION: Preoperative androgen therapy may reduce the odds of postoperative urethrocutaneous fistula in pediatric patients undergoing hypospadias repair, though this benefit was primarily observed in mixed-severity cohorts. No significant protective effect was demonstrated for glans dehiscence or meatal stenosis. Further high-quality RCTs with standardized protocols and long-term follow-up are warranted, particularly in distal hypospadias populations.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261351057, identifier CRD420261351057.
METHODS: PubMed, Web of Science, Cochrane Library, and CNKI were systematically searched (inception to March 15, 2026). Randomized controlled trials (RCTs) enrolling pediatric patients with hypospadias who received preoperative hormone therapy were included. Risk of bias was assessed using the Cochrane RoB 2 tool. The primary outcomes were postoperative urethrocutaneous fistula, glans dehiscence, and meatal stenosis. Bayesian network meta-analysis was performed using the gemtc package in R 4.3.1, and SUCRA was used to rank intervention efficacy. Sensitivity analysis excluding non-distal cohorts was performed to assess robustness.
RESULTS: Six RCTs (715 patients) were included. Direct pairwise meta-analysis showed that androgen therapy reduced the odds of urethrocutaneous fistula (pooled OR = 0.474; 95% CI: 0.241-0.934; P = 0.031). In the sensitivity analysis restricted to distal hypospadias only, the protective trend persisted but did not reach statistical significance (OR = 0.613; 95% CI: 0.285-1.319). No significant benefit of androgen was observed for glans dehiscence or meatal stenosis. Estrogen did not significantly reduce any complication. SUCRA analysis identified androgen as the most probable effective intervention for fistula prevention.
CONCLUSION: Preoperative androgen therapy may reduce the odds of postoperative urethrocutaneous fistula in pediatric patients undergoing hypospadias repair, though this benefit was primarily observed in mixed-severity cohorts. No significant protective effect was demonstrated for glans dehiscence or meatal stenosis. Further high-quality RCTs with standardized protocols and long-term follow-up are warranted, particularly in distal hypospadias populations.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261351057, identifier CRD420261351057.