Journal of pediatric surgery · 2026
Risk factors for urethrocutaneous fistula following primary hypospadias repair in children: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Khosravi Rahman, Alizadeh Hatef, Khosravi Hossein
Аннотация
BACKGROUND: Urethrocutaneous fistula remains the most common complication after hypospadias repair. We performed an updated systematic review and meta-analysis to identify modifiable and non-modifiable risk factors for fistula formation following primary hypospadias surgery.
METHODS: PubMed, Scopus, Embase, Web of Science, and Cochrane databases were systematically searched from January 2000 to November 2025. Studies reporting risk factors for urethrocutaneous fistula after primary pediatric hypospadias repair with extractable odds ratios or raw data were included. Pooled odds ratios (OR) and mean differences were calculated using random-effects models. PRISMA 2020 guidelines were followed.
RESULTS: Fourteen studies comprising 3794 patients were included. Proximal hypospadias (OR 2.03, 95 % CI 1.12-3.70) and one-stage repair (OR 1.67, 95 % CI 1.05-2.67) were significantly associated with higher fistula risk. Shorter postoperative stenting duration (<7 days) was associated with markedly increased odds (OR 3.96, 95 % CI 1.88-8.37) and longer urethral defect length (≥2 cm) with a modestly increased risk (OR 1.57, 95 % CI 1.05-2.33); however, both findings are derived from only two studies each, are imprecise, and should be considered hypothesis-generating rather than practice-changing. Age at surgery, chordee severity, suture material/technique, and urethroplasty method (TIP vs. Others) showed no significant association.
CONCLUSION: Proximal meatal location and one-stage repair are robust predictors of urethrocutaneous fistula (moderate certainty of evidence). Shorter postoperative stenting duration (<7 days) and longer urethral defect length (≥2 cm) show preliminary associations with higher risk (low certainty). These findings support preferential consideration of staged repair in proximal cases and prolonged stenting (≥7 days) in selected high-risk patients, while acknowledging the need for confirmatory trials. Age, suture characteristics, and choice of TIP versus flap techniques do not meaningfully affect fistula rates in modern series.
METHODS: PubMed, Scopus, Embase, Web of Science, and Cochrane databases were systematically searched from January 2000 to November 2025. Studies reporting risk factors for urethrocutaneous fistula after primary pediatric hypospadias repair with extractable odds ratios or raw data were included. Pooled odds ratios (OR) and mean differences were calculated using random-effects models. PRISMA 2020 guidelines were followed.
RESULTS: Fourteen studies comprising 3794 patients were included. Proximal hypospadias (OR 2.03, 95 % CI 1.12-3.70) and one-stage repair (OR 1.67, 95 % CI 1.05-2.67) were significantly associated with higher fistula risk. Shorter postoperative stenting duration (<7 days) was associated with markedly increased odds (OR 3.96, 95 % CI 1.88-8.37) and longer urethral defect length (≥2 cm) with a modestly increased risk (OR 1.57, 95 % CI 1.05-2.33); however, both findings are derived from only two studies each, are imprecise, and should be considered hypothesis-generating rather than practice-changing. Age at surgery, chordee severity, suture material/technique, and urethroplasty method (TIP vs. Others) showed no significant association.
CONCLUSION: Proximal meatal location and one-stage repair are robust predictors of urethrocutaneous fistula (moderate certainty of evidence). Shorter postoperative stenting duration (<7 days) and longer urethral defect length (≥2 cm) show preliminary associations with higher risk (low certainty). These findings support preferential consideration of staged repair in proximal cases and prolonged stenting (≥7 days) in selected high-risk patients, while acknowledging the need for confirmatory trials. Age, suture characteristics, and choice of TIP versus flap techniques do not meaningfully affect fistula rates in modern series.