Postoperative complications of Mathieu incised plate versus standard tubularized incised plate urethroplasty for distal hypospadias: a systematic review and meta-analysis

Abstract

Introduction: Surgical reconstruction is the mainstay treatment for distal hypospadias. A range of urethroplasty techniques is available with their benefits and disadvantages. We conducted a study to investigate the postoperative complications of Mathieu with plate incision technique relative to standard tubularized incised plate (TIP) technique in patients with distal hypospadias. Materials and Methods: The course of the study was referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Designated articles were clinical trials comparing postoperative complications of Mathieu with plate incision and standard TIP technique for distal hypospadias, systematically searched through PubMed and ScienceDirect databases. Pooled studies were analyzed in qualitative and quantitative methods. The protocol of this study was registered on PROSPERO (CRD42022341745). Results: Meta-analysis of the included studies yielded a significant difference in the postoperative incidence of meatal stenosis, narrow stream, and fistula formation of distal hypospadias patients in favor of Mathieu with plate incision compared to standard TIP technique, with Mantel-Haenszel test result of OR: 0.08 CI 0.01-0.41 (p = 0.003) for meatal stenosis; OR: 0.09 CI 0.02-0.49 (p = 0.006) for narrow stream; and OR: 0.28 CI 0.08-0.96 (p = 0.04) for fistula formation. All outcomes presented insignificant heterogeneity across studies (p > 0.05). Conclusion: The incidence of meatal stenosis, narrow stream, and fistula formation is lower in patients with distal hypospadias who underwent Mathieu with plate incision procedure than the standard TIP urethroplasty.