The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis

Safendra Siregar; Steven Steven; Akhmad Mustafa

doi:10.12688/f1000research.108503.2

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Systematic Review

Revised

The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis

[version 2; peer review: 1 approved, 2 approved with reservations]

Safendra Siregar ¹, Steven Steven¹, Akhmad Mustafa¹

PUBLISHED 30 Jan 2024

Author details Author details

¹ Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia

Safendra Siregar
Roles: Conceptualization, Data Curation, Methodology, Supervision, Writing – Review & Editing

Steven Steven
Roles: Data Curation, Investigation, Software, Writing – Original Draft Preparation

Akhmad Mustafa
Roles: Conceptualization, Investigation, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty.

Methods

The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term (“glue” OR “sealants” OR “tissue glue” OR “tissue sealant” OR “tissue adhesive”) AND (“hypospadias” OR “urethrocutaneous fistula” OR “urethral repair” OR “urethroplasty” OR “hypospadiology”).

Result

Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis.

Conclusions

This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.

Keywords

Hypospadias, Urethroplasty, Tissue Sealant, Benefit

Corresponding author: Safendra Siregar

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Siregar S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Siregar S, Steven S and Mustafa A. The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 11:184 (https://doi.org/10.12688/f1000research.108503.2) First published: 14 Feb 2022, 11:184 (https://doi.org/10.12688/f1000research.108503.1) Latest published: 30 Jan 2024, 11:184 (https://doi.org/10.12688/f1000research.108503.2)

Revised Amendments from Version 1

There are no major revisions in the manuscript. We update data with newer references.

See the authors' detailed response to the review by Borko Stojanovic

Introduction

Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males.¹ Hypospadias is a displaced urethral opening at the penis ventral side because of incomplete penile structures closure during embryogenesis.¹At present, there are more than 300 known methods of surgical management of hypospadias however, hypospadias repair remains a complex procedure, even for sophisticated urologiest and paediatrics surgeons.²

Nowadays, hypospadias can be successfully repaired through one-stage surgery in the majority of children.³^,⁴ Study by Arya et al., showed the overall success rate of one staged sugery was 73.5% that defined as no fistula, stricture, or residual chordee, and glandular meatus with acceptable cosmetic. The success rate after revision surgery reached 94.77%.⁵ However, several study found that staged uretroplasty with or without grafting gave higher success rate compared to single staged procedure.⁶^,⁷

In the recent past, the role of tissue sealants has been taken into consideration.⁸ Sealants are agents that can prevent the leakage of fluids by providing a physical barrier, which also aids in hemostasis.⁹ Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications.⁸ However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty.

Methods

Eligibility criteria

Criteria for inclusion:

1. The study was published in full-text and written in English.
2. Published between 2002 and 2021.
3. Randomized controlled trials (RCTs) or prospective cohort studies.
4. Participants aged up to 18 years, who required operative repair for hypospadias.
5. The intervention included tissue sealants usage.
6. The comparison was made with patients without tissue sealant (Control).
7. The outcome of the studies was the number of children with complication after sealant use.

Guidelines

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was used in reporting this study.⁷ The flow diagram can be found in Figure 1.

Figure 1. Study selection using PRISMA flow diagram.

Search strategy

The literature search was performed on PubMed, Embase, and Scopus following PRISMA guidelines (See reporting guidelines). The search was conducted on October 12th, 2021, using the search term (“glue” OR “sealants” OR “tissue glue” OR “tissue sealant” OR “tissue adhesive”) AND (“hypospadias” OR “urethrocutaneous fistula” OR “urethral repair” OR “urethroplasty” OR “hypospadiology”).

Data extraction

One reviewer (SS) performed literature selection and data extraction to an Excel database. Titles and abstracts were screened by two reviewers (SFS and AM) to determine the qualified articles. Next, the full text was reviewed to gather detailed information. Data were extracted by two reviewers (DK and SS) independently. Authors, study design, publication year, population, sample size, age, hypospadias severity, type of procedure performed, and characteristics of sealant information were extracted to Microsoft Excel. Any discrepancies among the observers were discussed until consensus was reached.

Result

Study selection

Systematic searching from all databases resulted in 160 potential articles (Figure 1). Duplicates were checked and excluded, leaving 79 articles. A total of 13 articles were qualified in this study. After a full-text review, eight articles were selected for review. These studies used various tissue sealant types. All the studies reported the procedure.

Study characteristics and key findings

The general characteristics of reviewed articles are listed in Table 1. All studies are prospective in study design. A total of 863 subjects with hypospadias were included. They were divided into the sealant and non-sealant groups, with 494 and 369 participants.

Table 1. Studies characteristics.

Study number	Author	Study design	Mean age	Sample size		Sealant type	The volume of sealant and technique
Study number	Author	Study design	Mean age	Sealant group	No sealant group	Sealant type	The volume of sealant and technique
1	Shenoy et al., 2021	Prospective	S-3.8 years N-4.6 years	20	20	Fibrin sealant	Application of fibrin sealant on the neo-urethra's suture line and no vascular cover was used
2	Hosseinpour et al., 2019	Prospective	-	300	100	Cryocalcium glue	5 ml of cryoprecipitate and 1 ml of calcium gluconate; thin layer on the urethral and dartos suture lines
3	Guinot et al., 2014	Prospective	S- median 8 months	33	72	Autologous PRF	The PRF was applied over the urethroplasty. A few interrupted suture with resorbable polyglyconate 7/0 was performed to secure the line.
4	Kocherov et al., 2014	Prospective	S-32.1 months N-26.7 months	20	20	BioGlue	A thin layer was formed on the neo-urethra's second suture line.
5	Hosseini et al., 2012	Prospective	13.5 months	20	41	Cyanoacrylate	Cyanoacrylate was poured over the glans. A rubbery consistency formed in 60 seconds, then reapplied 4-6 times.
6	Kajbafzadeh et al., 2011	Prospective	S-12.18 years	11	-	Fibrin glue	A fibrin glue layer over the closure area was applied, and the dartos fascia layer was brought over it. Another layer was placed and a skin closure was performed.
7	Gopal et al., 2008	RCT	S-28.02 months N-28.00 months	60	60	Fibrin glue	A thin layer in the urethral and dartos suture line
8	Ambriz-González et al., 2007	Prospective	S-33.5 months N-31.3 months	30	56	Fibrin glue	2 ml of fibrin glue over the surgical site and suture line

Shenoy et al.,¹¹ Gopal et al.,¹² and Ambriz-González et al.,¹³ used fibrin sealant in their study. There were several distinctions regarding the application of fibrin sealant. Shenoy et al.¹¹ applied the sealant on the neo-urethra's suture line, and no vascular cover was used. Then, Gopal et al.¹² made a thin layer of the sealant in the urethral and dartos suture line. Whereas Ambriz Gonzalez et al.¹³ applied 2 ml of fibrin glue over the surgical site and suture line.

In another study, Guinot et al.¹⁴ applied autologous platelet-rich fibrin (PRF) over urethroplasty. Meanwhile, Kajbafzadeh et al.¹⁵ aimed to determine fibrin sealant efficacy for UCF repair after multiple hypospadias and epispadias surgery. Over the closure area, a fibrin glue cover was made, and the dartos fascia layer was placed over this area.

Other sealants used in the included study were cryocalcium glue, BioGlue, and cyanoacrylate. Hosseinpour et al.¹⁶ used cryocalcium glue as a thin urethral layer and dartos suture lines. Kocherov et al.¹⁷ applied BioGlue as a thin cover on the the neo-urethra second suture line. Lastly, Hosseini et al.¹⁸ poured cyanoacrylate over the glans. A rubbery consistency was formed in 60 seconds, then reapplied 4-6 times.

Key findings of reviewed articles are listed in Table 2. Postoperative follow-up ranges between 7 days to 2 weeks to evaluate immediate complications, and between 1 month to 5 years to evaluate late complications. Hypospadias location differs from coronal, subcoronal, distal penile, etc. Some studies reported statistically significant differences of complication between the sealant and non-sealant groups. A study by Shenoy et al. reported distinction in early postoperative ooze, skin flap-related complications, and tension between the sealant and non-sealant groups (p<0.05).¹¹ Hosseinpour et al. revealed differences between edema and fistula (p=0.002).¹⁶ Kocherov et al. reported differences in poor cosmetic outcomes (p=0.007).¹⁷

Table 2. Main findings.

Study number	Author	Time to follow up	Hypospadias location/type		Main finding		Other findings
Study number	Author	Time to follow up	Sealant group	Non-sealant group	Sealant group	Non-sealant group
1	Shenoy et al., 2021	7 days after discharge, 1, 3, and 6 months	Coronal (1), subcoronal (9), distal penile (4), mid penile (4), proximal penile (1), penoscrotal (1)	Coronal (4), subcoronal (5), distal penile (1), mid-penile (7), proximal penile (1), and penoscrotal (2)	• Complications in 5 patients • Complications: coronal fistula (3), poor cosmetic outcome (3)	• Complications in 9 patients • Complications: early postoperative ooze (2), skin flap-related complications (3), UCF (7), poor cosmetic outcome (7), penile torsion (5)	• Differences in early postoperative ooze, skin flap-related complications and torsion were significant (p<0.05) • There were fewer patients with UCF and poor cosmetics in the fibrin sealant group • The overall improvement in outcome was found to be significantly different among the two groups, with a higher number in group 1 (p<0.05)
2	Hosseinpour et al., 2019	2 weeks of the procedure, then every 3 month	Distal penile (300)	Distal penile (100)	• Complications: edema (24), fistula (5), meatal stenosis (10)	• Complications: edema (15), fistula (6). Diverticulum (1), meatal stenosis (4)	• Statistically significant differences in edema (p=0.02) • Statistically significant differences in fistula (p=0.02) • No case of allergic in the case group
3	Guinot et al., 2014	2 month and 6 months post-operative	Distal (33)	Distal (72)	• Coronal fistula (2)	• Urethral fistula (3)	• No statistically significant difference between both groups (p=0.65)
4	Kocherov et al., 2014	15 ± 2.3 months after surgery (mean ± SD)	Distal shaft (7), mid-shaft (6), proximal shaft (1), peno-scrotal (6)	Distal shaft (8), mid-shaft (5), proximal shaft (1), peno-scrotal (6)	• Complications: UCF (4), breakdown of the suture line (4), meatal stenosis (1), poor cosmetic (n=12.6%)	• Complications: UCF (3), breakdown of the suture line (1), meatal stenosis (1), poor cosmetic (n=19.95%)	• Statistically significant differences in poor cosmetic (p=0.007)
5	Hosseini et al., 2012	2 weeks postoperative and six to twelve months	Type B and C hypospadias	Type B and C hypospadias	• Complications: hematoma (1), skin necrosis (1)	• Complications: hematomas (7), painful removal of the dressing (12), repeat dressing (10)	-
6	Kajbafzadeh et al., 2011	First 3 months from the date of surgery	Proximal hypospadias (8), epispadias (1), bladder exstrophy complex (1)	-	• Wound dehiscence (1), subcutaneous hematoma (1)	-	• A patient with the largest fistula (7 mm) had partial wound dehiscence.
7	Gopal et al., 2008	2 weeks of the procedure and then every 3 months for the 1^st year, then every 6 months for next 5 year	-	-	• Complications in 12 patients • Complications: postoperative edema (10), fistula (6), infection (4), meatal stenosis (3), proximal stricture (3).	• Complications in 34 patients • Complications: postoperative edema (21), fistula (19), diverticulum (3), infection (2), meatal stenosis (3), proximal stricture (10)	• Statistically significant differences in postoperative edema (p=0.039), fistula formation (p=0.027), and overall complication (p=0.003)
8	Ambriz-González et al., 2007	At least 6 months after surgery	Proximal shaft (8), medial shaft (7), distal shaft (15)	Proximal shaft (14), medial shaft (12), distal shaft (30)	• Complications: urethrocutaneous fistula (3), flap dehiscence (4), flap necrosis (2)	Complications: urethrocutaneous fistula (23), flap dehiscence (28), flap necrosis (16)	• Statistically significant differences in urethrocutaneous fistula (p=0.002), flap dehiscence (p=0.001), and flap necrosis (p=0.01)

Shenoy et al.¹¹ and Kajbafzadeh et al.¹⁵ reported less complication in the fibrin glue than in the non-sealant group. In the non-sealant group, the complications included early postoperative ooze, skin flap-related complications, UCF, poor cosmetic outcome, penile torsion, postoperative edema, diverticulum, meatal stenosis, proximal stricture, flap dehiscence, and flap necrosis. Early postoperative ooze, skin flap-related complications, and torsion were significantly different in the sealant and non-sealant groups (p<0.05). However, in a study by Kajbafzadeh et al.,¹⁵ the difference of complications between both groups was not statistically significant.

Hosseinpour et al.,¹⁶ in their study about the application of Cryocalcium glue, revealed that there was no allergy found in the sealant group. Then, Kocherov et al.¹⁷ reported poorer cosmetic outcomes in the non-sealant group compared to the BioGlue group (p=0.007). Subsequently, Hosseini et al.¹⁸ found poorer results in the non-sealant group than the cyanoacrylate group. His study revealed some complications, including hematomas, painful dressing removal, and repeat dressing.

In addition, Ambriz-González et al. compared the use of fibrin sealant on proximal, medial, and distal hypospadias.¹³ No statistically significant differences were found in the use of fibrin glue in proximal hypospadias to prevent complications. For medial hypospadias, fibrin glue was found to significantly reduce the occurrence of urethrocutaneus fistula (p=0.03) and flap dehiscence (p=0.001). Then, for distal hypospadias, fibrin glue was also found to reduce the occurrence of urethrocutaneus fistula (p=0.04) and flap dehiscence (p=0.04).¹³

The analysis of clinical and statistical findings were shown in Figure 2. We compared the occurance of complication after hypospadias repair. The occurrence of UCF was reported in all studies. UCF with sealant complication was the occurrence of complication reported by all studies was urethrocutaneous fistula. The pool risk ration (RR) for UCF was 0.47 (95% CI 0.30 – 0.73 p=0.001) compared to non-sealant group. Tissue edema and flap related complication also reported by several studies with pooled RR for tissue edema and flap related complication was 0.45 (95% CI0.29 – 0.71 p=0.0004) and 0.44 (95% CI 0.31 – 0.62 p<0.0001). Tissue sealant gave no significant effect in reducing meatal stenosis with Pool RR 0.9 (95% CI 0.38 – 2.15 p=0.8).

Figure 2. Forest plot: the occurrence of complication after urethroplasty (A: urethrocutanous fistula, B: tissue edema, C: meatal stenosis, D: Flap related complication).

Discussion

Hypospadias is a congenital anomaly discovered in 1 of every 300 live births.¹³ About 2-15% of infants with hypospadias experienced complications following repair procedures.¹⁹ The most common complications found, in order, are fistula, stricture, and dan wound breakdown.¹⁹ The need for hypospadias repairing technique, especially for cosmetic issues, is very demanding. The most popular technique for distal hypospadias surgery is 'tabularized incised plate urethroplasty’ or TIP and it is reported that the complication is as high as 5.5% with most common complication was UCF 0–10%.²⁰ Various tissue sealants were offered to gain a better seal of neo-urethra formation in the urologic procedures.¹⁷

This systematic review revealed five different sealant types were used in hypospadias repair. The sealants are classified into natural and synthetic. The natural sealants are made of albumin, fibrin, and cryocalcium, while the synthetic sealant is made of cyanoacrylate.

Fibrin glue

Fibrin glue contains fibrinogen-rich coagulation cascade, factor XII, dan thrombin.⁸ According to the coagulation cascade, scavenging macrophages will reabsorb the fibrin glue in 14 days so that it has a weak mechanical strength.⁵ Other complications are anaphylactic reaction and infection.²¹

Fibrin sealant has been used in many surgical procedures for hemostasis (topical agent) and tissue approximation (as an adhesive). Its usage has expanded through numerous procedures, including urologic surgery. Urologic procedures need the fibrin glue's sealing power to improve wound healing in penile urethroplasty.²²

Tisseel, a fibrin glue preparation, was first utilized by Kinahan et al. to enhance hypospadias repair.²³ In addition, Hick et al. stated that fibrin glue could be beneficial in promoting early catheter removal and accelerating the process of wound healing.²⁴ Study from Barbagli et al. shared their experience using fibrin glue in the buccal mucosa graft urethroplasty for bulbar urethral stricture.²⁵

Better postoperative outcomes were found in patients with fibrin sealant usage during surgery. There were no flap necrosis or penile torsion found as early postoperative complications.¹¹ Havez et al. stated this benefit might be influenced by the regeneration of the cellular and angiogenic of the tunica albuginea defect.²⁶ Urethra-cutaneous fistula was found less in the sealant group. They also had a better cosmetic outcome. There is a statistically significant improvement in the overall outcomes.²⁷

Another complication assessed in the study was postoperative edema. A larger number of early postoperative edema incidences in the non-sealant group might be due to undiscovered microscopic leakage in the tissue spaces between the suture lines. This could lead to a fistula formation.¹³ The application of fibrin glue forms an additional layer over the urethral tube, seals minute cracks between sutures, and decreases post-surgery edema. Therefore, its application might accelerate the wound healing process.¹³

Commercial fibrin sealants had a higher risk of allergic reactions compared to the homologous, blood bank product, fibrin sealants, which are prepared from single unit plasma. Risk of infection could be decreased by using autologous blood as the fibrinogen source. The setback is that the production took longer and created non-uniform fibrinogen concentration.²⁸^,²⁹ Kajbafzadeh et al. described fibrin glue's benefits preventing further recurrence in patients with recurrent fistula after hypospadias or epispadias repair.¹⁵

Autologous platelet-rich fibrin

Dohan et al.³⁰ developed platelet-rich fibrin (PRF) in the early 2000s that has been used to augment the process of tissue healing. The procedure is simple and less expensive than fibrin glue: the PRF patch is collected by centrifuging the autologous blood sample without any adjuvant. The patch creation could be done amid the urethroplasty procedure and used promptly.¹⁴^,³¹^,³²

A study by Guinot et al.¹⁴ found no negative effect of PRF as there were no adverse effects or skin infections discovered. Unfortunately, PRF superiority over conventional covering technique has not been proven.

Cryo-calcium glue

The use of cryo-calcium glue has been limited in underdeveloped or developing countries. This is due to its higher risk of infection transmission than fibrin glue, despite having been through donor screening, heat-treating, and the use of solvent and detergent suspension.¹⁶ The preparation of cyrocalcium glue is very simple and can be done during the urethroplasty procedure. It can be used shortly after its preparation.¹⁶ It is formed from combining a patient's cryoprecipitate and calcium gluconate.¹⁶

This cryo-calcium glue could be a safe and less expensive alternative than commercial fibrin glue to reduce fistula formation. The case group showed a minimal incidence of fistula by using cryo-calcium glue.¹⁶ It is also safe from allergic complications due to its autologous origin.¹⁶

BioGlue

In a prospective study, Kocherov et al. reported the efficacy of BioGlue in hypospadias repair.¹⁷ BioGlue does not carry a risk of infection transmissions, such as HIV, HBV, or HCV, different from natural human fibrin tissue sealant. Therefore, it appears to be an ideal sealant.³³ BioGlue consists of two purified bovine serum albumin and glutaraldehyde.³⁴ Glutaraldehyde acts to bridge the bovine serum albumin amine groups to the target tissue's extracellular matrix, forming a covalent bond between tissue and adhesive.³³ However, the advantages of BioGlue in reducing fistula formation and reconstruction breakdowns were not shown in the Kocherov et al. study.¹⁷ No difference in fistula formation and surgical breakdown were seen in both groups.¹⁷ In addition, the BioGlue group tends to have a more prominent severe fibrotic skin reaction, therefore inferior in cosmetics than the control group. Other publicity stated some discouraged effects of BioGlue, such as toxicity to tissue, local inflammation, and postoperative wound complications.³⁴^,³⁵ It is hypothesized due to glutaraldehyde toxicity.¹⁷

Cyanoacrylate

In a study by Hosseini et al., cyanoacrylate was used as a dressing in urethroplasty.¹⁸ This dressing has many purposes with others in edema restriction, hematoma formation, and wound stabilization if treated in several layers and lacks urine and feces permeability.¹⁸ There were no regular changes or pain upon removal. This type of dressing was more convenient for patients and the wound was kept hygienic at home. The occurrence of complications is less, 10% versus 30%; but late complications indirectly related to the dressing have been excluded.¹⁸

Prestipino et al. used cyanoacrylate in four patients with UCF. Three of them had fistula healing.³⁶ In another study, cyanoacrylate was used for simple sharp wounds in various locations, including the face and extremities, inguinal and umbilical hernia, cleft lip, hypospadias, and post-hypospadias fistula repair. The results showed improvement in efficacy, cosmetics, procedure duration, and patient comfort.³⁷

Tissue sealant effect

Based on our meta-analysis, tissue sealant can reduce urethroplasty complications during hypospadias repair. In our analysis, tissue sealant can reduce the occurrence of fistula urethocutan, tissue edema, and flap-related complication. This result is in line with the previous systematic review.⁵

Limitation

There are several limitations to this study. The included studies reported non-uniform complications. Information on the sealant and surgery cost of hypospadias repairment was limited. Moreover, several hypospadias types, various repair techniques used, and operator experience might serve as confounding factors as not all studies report on the complication and success rate based on the type of hypospadias.

Conclusion

This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant applied over the urethroplasty suture lines forms an adequate water-proof cover and improves outcomes in hypospadias repair. Fibrin glue reduces the incidence of complications in medial and distal hypospadias but not in proximal hypospadias. The application of PRF had no harmful effects, but it did not demonstrate superiority over conventional covering techniques. Cryocalcium glue could be used as an alternative to fibrin glue to reduce fistula formation. It is also safe and less expensive than fibrin glue. The use of cyanoacrylate dressing lessens the immediate complication of hypospadias repair surgery. Meanwhile, BioGlue does not show any additional advantages in hypospadias repair in pediatric patients than the standard procedures. A conclusion cannot be made due to studies diversity. Therefore, randomized controlled trials with a significant sample size are necessary to precisely compare the sealant and non-sealant groups, types of sealants, and hypospadias location.

Data availability

All data used in the research are available as part of articles and no additional source are needed to disclose.

Reporting guidelines

Figshare: PRISMA checklist for ‘The Benefit of Tissue Sealant on Urethroplasty in Hypospadias Patients – A Systematic Review and Meta-analysis’, DOI: 10.6084/m9.figshare.19102184.

Data are available under the terms of the Attribution 4.0 International license (CC BY 4.0)

Author contributions

SFS: Conceptualization, Methodology, Project administration, Supervision

SS: Data curation, Software, Writing original draft

AM: Conceptualization, Supervision, Validation, Wiriting review and editing

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20. Mahmud S, Tashfika UH, Ferdous KMN-u: Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience. Saudi J. Med. 2023; 8(1): 33–37. Publisher Full Text
21. Bao Z, Gao M, Sun Y, et al.: The recent progress of tissue adhesives in design strategies, adhesive mechanism and applications. Mater. Sci. Eng. C 2020; 111(March): 110796. PubMed Abstract | Publisher Full Text
22. Yang H, Xuan X, Hu D, et al.: Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies. BMC Urol. 2020; 20(1): 161. PubMed Abstract | Publisher Full Text
23. Kinahan TJ, Johnson HW: Tisseel in hypospadias repair. Canadian journal of surgery Journal canadien de chirurgie. 1992 Feb; 35(1): 75–77. PubMed Abstract
24. Hick EJ, Morey AF: Initial experience with fibrin sealant in pendulous urethral reconstruction. Is early catheter removal possible? J. Urol. 2004 Apr; 171(4): 1547–1549. PubMed Abstract | Publisher Full Text
25. Barbagli G, De Stefani S, Sighinolfi MC, et al.: Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft. Urology. 2006 Apr; 67(4): 830–832. PubMed Abstract | Publisher Full Text
26. Hafez AT, El-Assmy A, El-Hamid MA: Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model. BJU Int. 2004 Aug; 94(3): 433–436. PubMed Abstract | Publisher Full Text
27. Ambriz-González G, Aguirre-Ramirez P, García-De León JM, et al.: 2-octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: A randomized controlled trial. BMC Urol. 2014; 14(1): 2–7. Publisher Full Text
28. Moser C, Opitz I, Zhai W, et al.: Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: a prospective randomized blinded study. J. Thorac. Cardiovasc. Surg. 2008 Oct; 136(4): 843–849. PubMed Abstract | Publisher Full Text
29. de Hingh IHJT , Nienhuijs SW, Overdevest EP, et al.: Mesh fixation with autologous platelet-rich fibrin sealant in inguinal hernia repair. Eur. Surg. Res. 2009; 43(3): 306–309. PubMed Abstract | Publisher Full Text
30. Dohan DM, Choukroun J, Diss A, et al.: Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2006 Mar; 101(3): e37–e44. PubMed Abstract | Publisher Full Text
31. Joch C: The safety of fibrin sealants. Cardiovasc. Surg. (London, England). 2003 Aug; 11(Suppl 1): 23–28. PubMed Abstract | Publisher Full Text
32. Li Q, Pan S, Dangaria SJ, et al.: Platelet-rich fibrin promotes periodontal regeneration and enhances alveolar bone augmentation. Biomed. Res. Int. 2013; 2013: 638043.
33. Bahouth Z, Moskovitz B, Halachmi S, et al.: Bovine serum albumin-glutaraldehyde (BioGlue^®) tissue adhesive versus standard renorrhaphy following renal mass enucleation: a retrospective comparison. Ther. Adv. Urol. 2017; 9(3–4): 67–72. PubMed Abstract | Publisher Full Text
34. Fürst W, Banerjee A: Release of glutaraldehyde from an albumin-glutaraldehyde tissue adhesive causes significant in vitro and in vivo toxicity. Ann. Thorac. Surg. 2005 May; 79(5): 1522–1528; discussion 1529. PubMed Abstract | Publisher Full Text
35. Klimo PJ, Khalil A, Slotkin JR, et al.: Wound complications associated with the use of bovine serum albumin-glutaraldehyde surgical adhesive in pediatric patients. Neurosurgery. 2007 Apr; 60(4 Suppl 2): 305–309. discussion 309. PubMed Abstract | Publisher Full Text
36. Prestipino M, Bertozzi M, Nardi N, et al.: Outpatient department repair of urethrocutaneous fistulae using n-butyl-cyanoacrylate (NBCA): a single-centre experience. BJU Int. 2011 Nov; 108(9): 1514–1517. PubMed Abstract | Publisher Full Text
37. Castañón García-Alix M, Sancho Vendrell MA, Parri Ferrandis FJ, et al.: Utility of octyl 2-cyanoacrylate in pediatric surgery. Anales de Pediatria (Barcelona, Spain: 2003) 2003 Dec; 59(6): 548–551. Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 14 Feb 2022

Author details Author details

¹ Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia

Safendra Siregar
Roles: Conceptualization, Data Curation, Methodology, Supervision, Writing – Review & Editing

Steven Steven
Roles: Data Curation, Investigation, Software, Writing – Original Draft Preparation

Akhmad Mustafa
Roles: Conceptualization, Investigation, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 30 Jan 2024, 11:184

https://doi.org/10.12688/f1000research.108503.2

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Published: 14 Feb 2022, 11:184

https://doi.org/10.12688/f1000research.108503.1

© 2024 Siregar S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Siregar S, Steven S and Mustafa A. The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 11:184 (https://doi.org/10.12688/f1000research.108503.2)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 2

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PUBLISHED 30 Jan 2024

Revised

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Reviewer Report 05 Jul 2024

Shilpa Sharma, All India Institute of Medical Sciences, New Delhi, India

Approved with Reservations

https://doi.org/10.5256/f1000research.160687.r285077

The title states “The benefit of tissue sealant… However, the conclusion does not justify the title. I would suggest removing the first three words and beginning the title with “Tissue…
Introduction: The first two paragraphs

The title states “The benefit of tissue sealant… However, the conclusion does not justify the title. I would suggest removing the first three words and beginning the title with “Tissue…
Introduction: The first two paragraphs (para 1 and 2) are well-known facts and do not add anything new to the manuscript. The Introduction can start with paragraph 3.
More details, mechanism of action and concerns with the use of sealants such as fibrosis can be mentioned.
It is not understandable how meatal stenosis may be prevented by the application of a sealant. Rather, a sealant may be a cause of meatal stenosis by causing fibrosis. In the current study, the result may be interpreted as “application of sealants did not increase the incidence of meatal stenosis”. The statement “Tissue sealant gave no significant effect in reducing meatal stenosis with Pool RR 0.9 (95% CI 0.38 – 2.15 p=0.8)” may be modified accordingly
A table on the type of sealants and their composition will add value to the manuscript with a comparison of costs involved.
Minor grammatical errors may be corrected eg. Spelling of urethrocutaneous in abstract and Medial should be middle hypospadias.

The discussion can include more recent articles on the topic [1,2].

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Not applicable

References

1. Anand S, Özbey H, Sharma S: Looking beyond the dartos fascia and tunica vaginalis: reviewing the stance of common adjuvant covering biomaterials in hypospadiology.Am J Clin Exp Urol. 2022; 10 (2): 111-118 PubMed Abstract
2. Borkar N, Tiwari C, Mohanty D, Sinha A, et al.: Use of an Autologous Platelet-Rich Concentrate in Hypospadias Repair: A Systematic Review and Meta analysis.Arab J Urol. 2023; 21 (3): 177-184 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: pediatric urology, pediatric study, pediatric hepatobiliary surgery, pediatric colorectal surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 06 Feb 2024

Borko Stojanovic, Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia

Approved

https://doi.org/10.5256/f1000research.160687.r242337

The authors have made a substantial improvement of the manuscript. This is a very ... Continue reading

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PUBLISHED 14 Feb 2022

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Reviewer Report 07 Sep 2023

V V S Chandrasekharam, Ankura Hospitals for Women and Children, Hyderabad, Telengana, India

Approved with Reservations

https://doi.org/10.5256/f1000research.119884.r185863

This is a systematic review & meta-analysis (SR & MA) on an interesting topic. However, a similar review as published recently¹, which found no difference in the overall complication rate with the use of tissue sealants. The present article by Siregar et al has several drawbacks, some of which the authors themselves have observed and mentioned. Since an SR & MA represents a high level of evidence, it is important to apply certain stringent criteria to define the quality of the included studies.

In the methodology of SR, it is important to calculate the heterogeneity of the included papers by the use of I²statistics and Funnel plot. The publication bias of each included paper needs to be assessed and reported using methods such as Doi plot and LFK index. These statistics provide the reader with information regarding the comparability of the included papers and thus is a measure of the reliability of the results of the SR & MA. Without these data, it is impossible for the reader to arrive at any conclusions.
The authors themselves have acknowledged that the included studies have several shortcomings in their methodology, reporting of complications, type of sealant used and follow-up. This makes the results of the SR & MA unreliable.
In the discussion, the authors should compare their results with other similar studies¹ and explain the differences in the outcomes.
The single most important criteria for the success of hypospadias repair is the expertise and experience of the surgeon. This factor has not been discussed in the studies not in the SR & MA.

Thus, although this SR & MA is a good effort, the results must be interpreted with caution.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

No

References

1. Singh A, Anand S, Goel P, Yadav DK, et al.: Can sealing promote healing?: A systematic review and meta-analysis highlighting the adjunctive role of tissue sealant application during urethroplasty for hypospadias.J Pediatr Urol. 2021; 17 (6): 805-812 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: PEDIATRIC UROLOGY & Hypospadias

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Reviewer Report 28 Feb 2022

Borko Stojanovic, Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia

Approved with Reservations

https://doi.org/10.5256/f1000research.119884.r123542

This systematic review deals with a very interesting and up-to-date topic, since successful hypospadias repair still presents a great challenge. Literature data on the use of tissue sealant in urethroplasty show quite heterogeneous results, and authors made a very good choice to assess this by a systematic review. The methodology is based on PRISMA guidelines, with detailed explanation on search strategy, as well as good illustration of results. However, I have to note that the rest of the manuscript is poorly written, in several points:

The manuscript should be copy-edited to improve the quality of the writing.
Rationale and objectives are poorly explained, and introduction section needs more details and corrections, especially about the use of tissue sealant in hypospadias repair. Is it indicated in every case and form? What type of tissue sealant and when...?

Introduction Section: The sentence "Hypospadias can be successfully repaired through multiple surgeries in the majority of children" has to be corrected. Today, most of hypospadias cases are repaired by a one-stage surgery.

Introduction Section: "The overall success rate for first surgery was 55.9%.". Please provide reference. The rate of success is much higher today.

Abstract Section: "UCF complication was reported in all studies." Do not start a sentence with an acronym.
Some sentences within the Results and Discussion sections are unclear and require copy-editing.

Section Discussion: "Although superior in cosmetic issues, it is reported that the complication is as high as 20-30%.^17"I don't think this data is true, based on provided reference.
Diversity of the studies is large, and it should be primarily denoted in Conclusion section.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Paediatric urology

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Author Response 14 Jun 2024

Steven Steven, Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, 40161, Indonesia

14 Jun 2024

Author Response

Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Competing Interests: None
Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Competing Interests: None Close
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Author Response 14 Jun 2024

Steven Steven, Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, 40161, Indonesia

14 Jun 2024

Author Response

Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Competing Interests: None
Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Thank you for the review. We tried to revise the article in line with the recommendation you made. we also update several data according to newer articles.
Competing Interests: None Close
Report a concern

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VERSION 2 PUBLISHED 14 Feb 2022

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Borko Stojanovic, Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia; University of Belgrade, Belgrade, Serbia
V V S Chandrasekharam, Ankura Hospitals for Women and Children, Hyderabad, India
Shilpa Sharma, All India Institute of Medical Sciences, New Delhi, India

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Reviewer Report

7 Views

05 Jul 2024 | for Version 2

Shilpa Sharma, All India Institute of Medical Sciences, New Delhi, India

7 Views Cite this report Responses(0)

Approved With Reservations

The title states “The benefit of tissue sealant… However, the conclusion does not justify the title. I would suggest removing the first three words and beginning the title with “Tissue…
Introduction: The first two paragraphs (para 1 and 2) are well-known facts and do not add anything new to the manuscript. The Introduction can start with paragraph 3.
More details, mechanism of action and concerns with the use of sealants such as fibrosis can be mentioned.
It is not understandable how meatal stenosis may be prevented by the application of a sealant. Rather, a sealant may be a cause of meatal stenosis by causing fibrosis. In the current study, the result may be interpreted as “application of sealants did not increase the incidence of meatal stenosis”. The statement “Tissue sealant gave no significant effect in reducing meatal stenosis with Pool RR 0.9 (95% CI 0.38 – 2.15 p=0.8)” may be modified accordingly
A table on the type of sealants and their composition will add value to the manuscript with a comparison of costs involved.
Minor grammatical errors may be corrected eg. Spelling of urethrocutaneous in abstract and Medial should be middle hypospadias.

The discussion can include more recent articles on the topic [1,2].

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Not applicable

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

pediatric urology, pediatric study, pediatric hepatobiliary surgery, pediatric colorectal surgery

Respond to this report

Responses (0)

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Reviewer Report

7 Views

06 Feb 2024 | for Version 2

Borko Stojanovic, Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia

7 Views Cite this report Responses(0)

Approved

The authors have made a substantial improvement of the manuscript. This is a very important topic, and this systematic review/meta analysis will be beneficial in hypospadias surgery and literature.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Paediatric urology

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

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Reviewer Report

8 Views

07 Sep 2023 | for Version 1

V V S Chandrasekharam, Ankura Hospitals for Women and Children, Hyderabad, Telengana, India

8 Views Cite this report Responses(0)

Approved With Reservations

In the methodology of SR, it is important to calculate the heterogeneity of the included papers by the use of I²statistics and Funnel plot. The publication bias of each included paper needs to be assessed and reported using methods such as Doi plot and LFK index. These statistics provide the reader with information regarding the comparability of the included papers and thus is a measure of the reliability of the results of the SR & MA. Without these data, it is impossible for the reader to arrive at any conclusions.
The authors themselves have acknowledged that the included studies have several shortcomings in their methodology, reporting of complications, type of sealant used and follow-up. This makes the results of the SR & MA unreliable.
In the discussion, the authors should compare their results with other similar studies¹ and explain the differences in the outcomes.
The single most important criteria for the success of hypospadias repair is the expertise and experience of the surgeon. This factor has not been discussed in the studies not in the SR & MA.

Thus, although this SR & MA is a good effort, the results must be interpreted with caution.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Partly
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

No

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

PEDIATRIC UROLOGY & Hypospadias

Respond to this report

Responses (0)

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Reviewer Report

21 Views

28 Feb 2022 | for Version 1

Borko Stojanovic, Belgrade Centre for Urogenital Reconstructive Surgery, Belgrade, Serbia; School of Medicine, University of Belgrade, Belgrade, Serbia

21 Views Cite this report Responses(1)

Approved With Reservations

The manuscript should be copy-edited to improve the quality of the writing.
Rationale and objectives are poorly explained, and introduction section needs more details and corrections, especially about the use of tissue sealant in hypospadias repair. Is it indicated in every case and form? What type of tissue sealant and when...?

Introduction Section: The sentence "Hypospadias can be successfully repaired through multiple surgeries in the majority of children" has to be corrected. Today, most of hypospadias cases are repaired by a one-stage surgery.

Introduction Section: "The overall success rate for first surgery was 55.9%.". Please provide reference. The rate of success is much higher today.

Abstract Section: "UCF complication was reported in all studies." Do not start a sentence with an acronym.
Some sentences within the Results and Discussion sections are unclear and require copy-editing.

Section Discussion: "Although superior in cosmetic issues, it is reported that the complication is as high as 20-30%.^17"I don't think this data is true, based on provided reference.
Diversity of the studies is large, and it should be primarily denoted in Conclusion section.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Paediatric urology

Respond to this report

Responses (1)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Singh A, Anand S, Goel P, et al.: Can sealing promote healing?: A systematic review and meta-analysis highlighting the adjunctive role of tissue sealant application during urethroplasty for hypospadias. J. Pediatr. Urol. 2021; 17: 805–812. PubMed Abstract | Publisher Full Text

[2] 2. van der Horst HJR , de Wall LL : Hypospadias, all there is to know. Eur. J. Pediatr. 2017; 176(4): 435–441. Publisher Full Text

[3] 3. Akramov NR, Kagantsov IM, Sizonov VV, et al.: Advancement urethroplasty for distal hypospadias repair without dismembering urethra spongy body and glans penis. Urology Herald. 2020; 8(3): 5–12. Publisher Full Text

[4] 4. Wasel MF, Hammady AR, Mostafa MH: One stage versus two stage repair of hypospadias with marked chordae: a non randomized comparative study. Sohag J. Sci. 2023; 27(3): 26–33. Publisher Full Text

[5] 5. Arya MC, Daga RN, Gandhi A, et al.: Single Stage Hypospadias Repair In Primary Cases And Their Patient Related Outcomes—Tertiary Care Center Experience. Indones. J. Urol. 2022; 29(3). Publisher Full Text

[6] 6. Wu Y, Guan Y, Wang X, et al.: Repair of proximal hypospadias with single-stage (Duckett’s method) or Bracka two-stage: a retrospective comparative cohort study. Transl. Pediatr. 2023; 12(3): 387–395. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Wang Y-S, Song H-C, Liu P, et al.: Comparison of outcomes in three surgical techniques for proximal hypospadias: staged transverse preputial island flap urethroplasty versus single-stage repairs. Asian J. Androl. 2023 Jan 3; 25(5): 616–620. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Mammo TN, Negash SA, Negussie T, et al.: Hypospadias Repair in Ethiopia: A Five Year Review. Ethiop. J. Health Sci. 2018; 28(6): 735–740. PubMed Abstract | Publisher Full Text

[9] 9. Kommu SS, McArthur R, Emara AM, et al.: Current Status of Hemostatic Agents and Sealants in Urologic Surgical Practice. Rev. Urol. 2015; 17(3): 150–159. PubMed Abstract | Free Full Text

[10] 10. Moher D, Liberati A, Tetzlaff J, et al.: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int. J. Surg. 2010; 8(5): 336–341. PubMed Abstract | Publisher Full Text

[11] 11. Shenoy NS, Tiwari C, Gandhi S, et al.: Efficacy of fibrin sealant as waterproof cover in improving outcome in hypospadias surgery. Afr. J. Paediatr. Surg. 2021; 18(4): 215–218. PubMed Abstract | Publisher Full Text

[12] 12. Gopal SC, Gangopadhyay AN, Mohan TV, et al.: Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair. J. Pediatr. Surg. 2008 Oct; 43(10): 1869–1872. Publisher Full Text

[13] 13. Ambriz-González G, Velázquez-Ramírez GA, García-González JL, et al.: Use of fibrin sealant in hypospadias surgical repair reduces the frequency of postoperative complications. Urol. Int. 2007; 78(1): 37–41. Publisher Full Text

[14] 14. Guinot A, Arnaud A, Azzis O, et al.: Preliminary experience with the use of an autologous platelet-rich fibrin membrane for urethroplasty coverage in distal hypospadias surgery. J. Pediatr. Urol. 2014; 10(2): 300–305. PubMed Abstract | Publisher Full Text

[15] 15. Kajbafzadeh AM, Abolghasemi H, Eshghi P, et al.: Single-donor fibrin sealant for repair of urethrocutaneous fistulae following multiple hypospadias and epispadias repairs. J. Pediatr. Urol. 2011; 7(4): 422–427. PubMed Abstract | Publisher Full Text

[16] 16. Hosseinpour M, Etezazian S, Hamsaieh M: Cryocalcium Glue in Hypospadias Surgery. J. Indian Assoc. Pediatr. Surg. 2019; 24(3): 226–227. PubMed Abstract | Publisher Full Text

[17] 17. Kocherov S, Lev G, Chertin B: Use of BioGlue surgical adhesive in hypospadias repair. Curr. Urol. 2014; 7(3): 132–135. PubMed Abstract | Publisher Full Text

[18] 18. Hosseini SMV, Rasekhi AR, Zarenezhad M, et al.: Cyanoacrylate glue dressing for hypospadias surgery. N. Am. J. Med. Sci. 2012; 4(7): 320–322. PubMed Abstract | Publisher Full Text

[19] 19. Snodgrass WT: Tubularized incised plate hypospadias repair: indications, technique, and complications. Urology. 1999 Jul; 54(1): 6–11. PubMed Abstract | Publisher Full Text

[20] 20. Mahmud S, Tashfika UH, Ferdous KMN-u: Outcome of Classical Tubularized Incised-Plate Urethroplasty (TIP) for Primary Anterior Hypospadias Repair: 5 Years’ Experience. Saudi J. Med. 2023; 8(1): 33–37. Publisher Full Text

[21] 21. Bao Z, Gao M, Sun Y, et al.: The recent progress of tissue adhesives in design strategies, adhesive mechanism and applications. Mater. Sci. Eng. C 2020; 111(March): 110796. PubMed Abstract | Publisher Full Text

[22] 22. Yang H, Xuan X, Hu D, et al.: Comparison of effect between dartos fascia and tunica vaginalis fascia in TIP urethroplasty: a meta-analysis of comparative studies. BMC Urol. 2020; 20(1): 161. PubMed Abstract | Publisher Full Text

[23] 23. Kinahan TJ, Johnson HW: Tisseel in hypospadias repair. Canadian journal of surgery Journal canadien de chirurgie. 1992 Feb; 35(1): 75–77. PubMed Abstract

[24] 24. Hick EJ, Morey AF: Initial experience with fibrin sealant in pendulous urethral reconstruction. Is early catheter removal possible? J. Urol. 2004 Apr; 171(4): 1547–1549. PubMed Abstract | Publisher Full Text

[25] 25. Barbagli G, De Stefani S, Sighinolfi MC, et al.: Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft. Urology. 2006 Apr; 67(4): 830–832. PubMed Abstract | Publisher Full Text

[26] 26. Hafez AT, El-Assmy A, El-Hamid MA: Fibrin glue for the suture-less correction of penile chordee: a pilot study in a rabbit model. BJU Int. 2004 Aug; 94(3): 433–436. PubMed Abstract | Publisher Full Text

[27] 27. Ambriz-González G, Aguirre-Ramirez P, García-De León JM, et al.: 2-octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: A randomized controlled trial. BMC Urol. 2014; 14(1): 2–7. Publisher Full Text

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The benefit of tissue sealant on urethroplasty in hypospadias patients – A systematic review and meta-analysis

Abstract

Background

Methods

Result

Conclusions

Keywords

Revised Amendments from Version 1

Introduction

Methods

Eligibility criteria

Guidelines

Figure 1. Study selection using PRISMA flow diagram.

Search strategy

Data extraction

Result

Study selection

Study characteristics and key findings

Table 1. Studies characteristics.

Table 2. Main findings.

Figure 2. Forest plot: the occurrence of complication after urethroplasty (A: urethrocutanous fistula, B: tissue edema, C: meatal stenosis, D: Flap related complication).

Discussion

Fibrin glue

Autologous platelet-rich fibrin

Cryo-calcium glue

BioGlue

Cyanoacrylate

Tissue sealant effect

Limitation

Conclusion

Data availability

Reporting guidelines

Author contributions

References

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