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

SummaryBackgroundThe 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.MethodsA 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.ResultsAfter 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).ConclusionsWith 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.