Comparative outcome of tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty in distal hyposapadias: a systematic review and meta-analysis of randomised controlled trials [Oral presentation]

Abstract

<p><b>Purpose: </b>Hypospadias repair is a complex reconstructive urological procedure in children. It is associated with significant early complications as well as possible long-term squalene. Various repair techniques are available; however, to date, little has been published in the literature on the comparative outcome of tubularized incised plate urethroplasty (TIP) and dorsal inlay graft urethroplasty in distal hypospadias (G-TIP).<br></p><p><b>Methods:</b> We searched PubMed, Medline, Embase and Cochrane Trials databases for randomised controlled trials that compare TIP and G-TIP operations in children from 1st Jan 2005 to 31st Oct 2024. We assessed the identified trials for quality, performed a systematic review and meta-analysis in accordance with PRISMA and registered in PROSPERO. The main outcome measures examined were occurrence of urocutanesous fistula and meatal stenosis which were analysed using random effects models. We also compared the operating time between the two operations.<br></p><p><b>Results: </b>We included four eligible trials, with a total of 272 enrolled patients. Random effect model analysis showed that G-TIP group had significantly lower occurrence of meatal stenosis when compared to TIP group (RR 0.29 ;95% CI: 0.19 - 0.46, p = 0.003). Urocutaneous fistula, although not statically significant, occurred less in graft group (RR 0.52; 95% CI: 0.02 - 11.8, p=0.46). G-TIP Group demonstrated a significantly longer operative time. There is no heterogeneity in the reports and the funnel plot showed no publication bias.<br></p><p><b>Conclusion:</b> Current evidence demonstrates that G-TIP is associated with better functional outcome in selected patients with distal hypospadias. Future adequately powered and well-designed trials are necessary to improve understanding of the optimal treatment modality for distal hypospadias.<br></p>