目的:我们进行了系统评价和荟萃分析,总结了术前激素刺激对近端尿道下裂修复后并发症发生率的影响。
方法:我们全面检索了1990年至2010年之间已发表和未发表的文献。适用资格标准。Title,摘要和全文筛选由两名独立作者进行,差异以协商一致方式解决。使用Cochran卡方Q检验测试研究之间的异质性,并通过计算I(2)进行量化。对纳入研究进行质量评价。适当时使用随机效应模型进行Meta分析。
结果:我们的搜索产生了288个引用,其中11例(622例)符合纳入标准,纳入系统综述.大多数系列是中等或低方法学质量的回顾性观察性研究。45%的患者接受了术前激素刺激,肌肉内睾酮是最常用的处方。四项研究解决了根据术前激素刺激使用分层的术后并发症发生率,并纳入了荟萃分析。术前使用激素刺激发生并发症的比值比为1.67(CI0.96-2.91,p=0.07,I(2)=0%)。没有报告由于术前激素刺激引起的持续副作用。
结论:据我们所知,这是迄今为止唯一的系统评价和荟萃分析,它严格评估了术前激素刺激对尿道下裂修复后手术结局的影响。已发表的文献质量较低,缺乏对重要患者和手术细节的标准化报告。术前激素刺激对尿道下裂修复后手术结果的影响尚不清楚,需要进一步研究。
OBJECTIVE: We conducted a systematic
review and meta-analysis to summarize the effect of preoperative hormonal stimulation on complication rates following proximal hypospadias repair.
METHODS: We comprehensively searched the published and unpublished literature between 1990 and 2010. Eligibility criteria were applied. Title, abstract and full text screening was carried out by 2 independent authors, and discrepancies were resolved by consensus. Heterogeneity between studies was tested using Cochran chi-square Q test and quantified by calculating I(2). Quality appraisal of included studies was performed. Meta-analysis was conducted when appropriate using a random effects model.
RESULTS: Our search yielded 288 citations, of which 11 (622 patients) met inclusion criteria and were incorporated into the systematic
review. Most series were retrospective observational studies of moderate or low methodological quality. Of the patients 45% underwent administration of preoperative hormonal stimulation, with intramuscular testosterone being the most commonly prescribed formulation. Four studies addressed postoperative complication rate stratified by preoperative hormonal stimulation use and were included in a meta-analysis. The odds ratio for a complication occurring with preoperative hormonal stimulation use was 1.67 (CI 0.96-2.91, p = 0.07, I(2) = 0%). No persistent side effects due to preoperative hormonal stimulation were reported.
CONCLUSIONS: To our knowledge this is the only systematic
review and meta-analysis thus far that has critically assessed the effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair. The published literature is of low quality and lacks standardized reporting of important patient and surgical details. The effect of preoperative hormonal stimulation on operative outcomes after hypospadias repair remains unclear and requires further investigation.