Michael E Chua1, Michele Gnech2, Jessica M Ming1, Jan Michael Silangcruz3, Stephanie Sanger4, Roberto Iglesias Lopes5, Armando J Lorenzo1, Luis H Braga6. 1. Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada. 2. Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Section of Pediatric Urology, Urology Unit, University Hospital of Padova, Padua, Italy. 3. Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Philippines. 4. Health Sciences Library, McMaster University, Hamilton, ON, Canada. 5. Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada. 6. Department of Urology, McMaster Children's Hospital and University, Hamilton, ON, Canada; Department of Surgery/Urology, McMaster University, Hamilton, ON, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. Electronic address: braga@mcmaster.ca.
Abstract
INTRODUCTION: Preoperative hormonal stimulation (PHS) is commonly administered to improve hypospadias outcomes. However, current literature provides no clear evidence to support its use, and controversies exist regarding its effect on postoperative complications. Herein we systematically evaluate the effect of PHS on postoperative complications rates following hypospadias repair. MATERIALS AND METHODS: Comprehensive literature search performed on April 2016 including OVID MEDLINE, EMBASE, Web of Science, Cochrane Library, Clinicaltrials.gov, World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and ProQuest. Study quality assessment followed the Cochrane collaboration recommendation using risk of bias assessment, ROBINS-I and NOQAS. Effect estimates were extracted as relative risk (RR) with 95% confidence interval (CI) and pooled using Mantel-Haenzel method. Evidence quality was assessed using GRADE approach. Protocol Registration: PROSPERO CRD42016037881. RESULTS: Twenty-one publications from 16 trials examining the effect of androgenic PHS on postoperative outcome were included. Subgroup analysis based on study design (including nine cohort studies with moderate to high risk of bias for patient selection) showed no significant difference on postoperative outcomes (RR 1.31, 95% CI 0.95-1.81) (table). Pooled effect estimates with moderate quality of evidence from three randomized controlled trials suggest that significant lesser postoperative complications occur among patients exposed to PHS (RR 0.36, 95% CI 0.20-0.65). Uniformly, the reported adverse effects related to PHS were mild and transient, with good overall tolerance. CONCLUSIONS: Effect estimates generated from the better quality of evidence showed that PHS may decrease postoperative complications following hypospadias repair. Future studies should aim at identifying indicated subgroup of patients that will benefit from it and standardizing the dose and mode of delivery for best clinical result.
INTRODUCTION: Preoperative hormonal stimulation (PHS) is commonly administered to improve hypospadias outcomes. However, current literature provides no clear evidence to support its use, and controversies exist regarding its effect on postoperative complications. Herein we systematically evaluate the effect of PHS on postoperative complications rates following hypospadias repair. MATERIALS AND METHODS: Comprehensive literature search performed on April 2016 including OVID MEDLINE, EMBASE, Web of Science, Cochrane Library, Clinicaltrials.gov, World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and ProQuest. Study quality assessment followed the Cochrane collaboration recommendation using risk of bias assessment, ROBINS-I and NOQAS. Effect estimates were extracted as relative risk (RR) with 95% confidence interval (CI) and pooled using Mantel-Haenzel method. Evidence quality was assessed using GRADE approach. Protocol Registration: PROSPERO CRD42016037881. RESULTS: Twenty-one publications from 16 trials examining the effect of androgenic PHS on postoperative outcome were included. Subgroup analysis based on study design (including nine cohort studies with moderate to high risk of bias for patient selection) showed no significant difference on postoperative outcomes (RR 1.31, 95% CI 0.95-1.81) (table). Pooled effect estimates with moderate quality of evidence from three randomized controlled trials suggest that significant lesser postoperative complications occur among patients exposed to PHS (RR 0.36, 95% CI 0.20-0.65). Uniformly, the reported adverse effects related to PHS were mild and transient, with good overall tolerance. CONCLUSIONS: Effect estimates generated from the better quality of evidence showed that PHS may decrease postoperative complications following hypospadias repair. Future studies should aim at identifying indicated subgroup of patients that will benefit from it and standardizing the dose and mode of delivery for best clinical result.
Authors: Patrick Pine Tanseco; Harkanwal Randhawa; Michael Erlano Chua; Udi Blankstein; Jin Kyu Kim; Melissa McGrath; Armando J Lorenzo; Luis H Braga Journal: Can Urol Assoc J Date: 2018-12-03 Impact factor: 1.862
Authors: Kiarash Taghavi; Lomani A O'Hagan; Jacqueline K Hewitt; Pierre DE Mouriquand Journal: J Paediatr Child Health Date: 2022-07-06 Impact factor: 1.929