Surgical approaches for distal urethral strictures after failed hypospadias repair: a systematic review and meta-analysis.

Abstract

Urethral stricture is a frequent complication following hypospadias repair, often complicated by scarring, anatomical distortion, and poor tissue vascularity. This systematic review and meta-analysis evaluated outcomes of single-stage versus staged urethroplasty for distal urethral strictures after failed hypospadias repair. A total of 20 studies were analyzed. Data were extracted regarding surgical techniques, success rates, complications, and duration of follow-up. Meta-analysis showed a pooled success rate of 78.1% (95% CI: 70.2-84.4%) for single-stage and 76.2% (95% CI: 52.1-90.4%) for staged procedures. The difference in efficacy was not statistically significant. Single-stage repairs were generally associated with shorter treatment durations, while staged approaches were preferred in cases with severe fibrosis or poor tissue quality. Complication rates ranged from 10% to 50%. In staged procedures, the use of buccal mucosa grafts yielded better outcomes compared to skin flaps or other grafts. Significant heterogeneity was observed (I² = 65.2% for single-stage, I² = 90.1% for staged; p < 0.01), likely due to variability in surgical techniques, patient demographics, and follow-up protocols. No publication bias was detected (Egger's test p = 0.398 and 0.388, respectively). Further standardized, prospective studies are necessary to optimize treatment selection and to enhance surgical outcomes.