目的:总结现有证据并定量评估不同防水层在证实UCF修复方面的总体结果。
方法:定义研究方案后,审查是根据PRISMA指南由一个由尿道放射学专家组成的小组进行的,系统评价和荟萃分析,流行病学,生物统计学和数据科学。从2000年开始发表的研究报告,在PUBMED上搜索尿道下裂修复后UCF闭合结果的报告,Embase和谷歌学者。使用JoannaBriggs检查表(JBI)关键评估工具评估研究质量。在MicrosoftExcel的帮助下,将不同技术的结果与两个样品独立比例测试进行了比较,MedCalc软件和在线计算器。
结果:73项研究入围了综合研究;最终分析包括539例UCF修复失败的2886例患者(71项研究)。已生成UCF修复所涉及的各种维度的摘要,包括上次手术后的时间间隔,支架-vs-无支架,耻骨上导管插入术,缝合材料,缝合技术,相关异常,并发症,等。计算并比较了与不同技术相关的成功率:简单导管插入(100%),简单初级闭包(73.2%),dartos(78.8%),双dartos皮瓣(81%),阴囊皮瓣(94.6%),鞘膜(94.3%),PATIO修复(93.5%),生物材料或真皮替代品(92%),生物相容性粘合剂(56.5%)和基于皮肤的皮瓣(54.5%)。几种技术被确定为单独的出版物并进行了讨论。
结论:阴道膜瓣和阴囊瓣在UCF闭合后的合成效果最好。然而,不可能将任何技术标记为理想或完美。几乎所有流行的防水层有时都表现出绝对(100%)的成功。还有大量其他因素(患者的局部解剖学,外科医生的专业知识和技术观点)影响最终结果。
OBJECTIVE: To summarize the available evidence and to quantitatively evaluate the global results of different waterproofing layers in substantiating the UCF repair.
METHODS: After defining the study protocol, the review was conducted according to the PRISMA guidelines by a team comprising experts in hypospadiology, systematic reviews and meta-analysis, epidemiology, biostatistics and data science. Studies published from 2000 onwards, reporting on the results of UCF closure after hypospadias repair were searched for on PUBMED, Embase and Google Scholar. Study quality was assessed using Joanna Briggs Checklist (JBI) critical appraisal tool. The results with different techniques were compared with the two samples independent proportions test with the help of Microsoft Excel, MedCalc software and an online calculator.
RESULTS: Seventy-three studies were shortlisted for the synthesis; the final analysis included 2886 patients (71 studies) with UCF repair failure in 539. A summary of various dimensions involved with the UCF repair has been generated including time gap after last surgery, stent-vs-no stent, supra-pubic catheterization, suture material, suturing technique, associated anomalies, complications, etc. The success rates associated with different techniques were calculated and compared: simple catheterization (100%), simple primary closure (73.2%), dartos (78.8%), double dartos flaps (81%), scrotal flaps (94.6%), tunica vaginalis (94.3%), PATIO repair (93.5%), biomaterials or dermal substitutes (92%), biocompatible adhesives (56.5%) and skin-based flaps (54.5%). Several techniques were identified as solitary publications and discussed.
CONCLUSIONS: Tunica vaginalis and scrotal flaps offer the best results after UCF closure in the synthesis. However, it is not possible to label any technique as ideal or perfect. Almost all popular waterproofing layers have depicted absolute (100%) success sometimes. There are a vast number of other factors (patient\'s local anatomy, surgeon\'s expertise and technical perspectives) which influence the final outcome.