Fistula after single-stage primary hypospadias repair - A systematic review of the literature

Background: The reporting of fistula after hypospadias repair varies greatly in the worldwide literature, with incidence ranging from 0% to over 35%. With multiple techniques employed within a heterogeneous patient cohort, to date, no "average" incidence of fistula has been reported. Methods: A systematic review of the contemporary English-language literature from 2005 to 2015 identifying articles reporting complications after primary, single-stage hypospadias repair (the most commonly performed hypospadias operation) was performed. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and the Methodological Index or Non-Randomized Studies (MINORS). A random effects analysis model was produced, in order to calculate a pooled outcome rates across the included studies. Separate models were then produced for subgroups of studies, with the resulting pooled rates compared. Results: After application of inclusion and exclusion criteria, 44 articles progressed to the final analysis. A total of 6603 patients were included. The incidence of fistula was 7.5% (95% CI: 5.8-9.4), stricture or stenosis 4.4% (95% CI: 3.1-5.8) and dehiscence 2.1% (95% CI: 1.3-3.1). Conclusions: With pooled proportions of complications from over 6600 patients over a 10-year period, a standard may be set for outcomes after single-stage primary hypospadias repair for surgeons to audit their own outcomes against. (C) 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.