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MINERVA UROLOGICA E NEFROLOGICA
Rivista di Nefrologia e Urologia
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Urologica e Nefrologica 2016 May 10
Impact of pre-operative hormonal stimulation on post-operative complication rates after hypospadias repair: a meta-analysis
Min CHAO 1, 2, Yin ZHANG 2, Chaozhao LIANG 1 ✉
1 Department of Urology, Anhui Provincial Children’s Hospital, Hefei, Anhui, China; 2 Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
BACKGROUND: To improve the surgical outcome of hypospadias repair surgery, pre-operative hormonal stimulation (PHS) has been proposed. We conducted a meta-analysis to evaluate the impact of pre-operative hormonal stimulation (PHS) treatment on complication rates following hypospadias repair surgery.
METHODS: A comprehensive literature search up to 1st June 2015 was carried out for relevant studies. After literature identification and data extraction, relative ratio (RR) was calculated to compare post-operative complication rates. Heterogeneity among individual studies was tested using the Cochran chi-square Q test and quantified by calculating the I2 index. Meta-regression was applied to find potential affective factors.
RESULTS: 428 patients in 6 studies had undergone primary hypospadias repair, of which 171 (39.95%) received some form of Pre-Operative Hormonal Stimulation with human chorionic gonadotropin (HCG), dihydrotestosterone (DHT) or testosterone (T). They underwent 3 different types of surgical techniques, which included Onlay Island Flap (OIL) (277 patients), Tubularized Incised plate (TIP) (99 patients) and Koyanagi urethroplasty (52 patients). These 6 studies classified the complication rates based on PHS. The relative ratio (RR) for a complication occurring following PHS use was 1.18 (95%CI= 0.70–2.00, Z=0.91, P=0.539). Significant heterogeneity (I2 =47.1%,P=0.092) among various research literature was found and meta-regression was undertaken for the heterogeneity, but surgical technique, mean age of patients at time of surgery, types of PHS and the quality of studies were not the cause of heterogeneity.
CONCLUSIONS: Use of T, DHT and HCG prior to hypospadias repair does not appear to increase the incidence of post-operative complications, but there is need for further investigation.