A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

Abstract Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in TIP repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis. But there is limited for other hypospadias operative techniques and fistula repair. registration number: PROSPERO CRD42019148554