A Meta Analysis Of Modified Koyanagi Technique And Duckett + Dupaly Technique In The One-stage Treatment Of Proximal Hypospadias

Objective: To evaluate the clinical effect of one-stage operation with modified Koyanagi technique and Duckett + Duplay technique in the treatment of proximal hypospadias,and to provide evidence-based medical evidence for the selection of surgical methods in the treatment of proximal hypospadias.Methods: Through electronic retrieval of all relevant documents in the electronic databases of Cochrane Library,EMBASE,Pub Med / MEDLINE,Ovid,CNKI,Wanfang medical database,and VIP(all from January 1998 to January 2020),Chinese Journal of Urology,Chinese Journal of andrology,Journal of clinical pediatric surgery,Journal of Modern Urology,Journal of clinical urology and Chinese Journal of Andrology were searched manually.We also contacted relevant research authors to collect complete data.Two systematic evaluators independently selected documents,extracted data,evaluated methodological quality and biased risk.Use review manage 5.3 software for meta analysis.Results: This study included 5 eligible literatures.Including 462 patients,227 patients were treated with modified Koyanagi technique and 235 patients were treated with Duckett + Duplay technique.According to the bias risk assessment tools and judgment criteria of Cochrane collaborative network,there was no significant evidence that there was a high risk bias source.The Meta analysis results showed that: 1.Incidence of urethral fistula: there was no statistical difference between the two groups.2.The incidence of urethral stricture: the Z value of the combined statistic was 3.01,P = 0.003 < 0.05,which indicated that there was a statistical difference in the incidence of urethral stricture after the modified Koyanagi technique and Duckett + Duplay technique for the treatment of proximal hypospadias,suggesting that the incidence of urinary tract stricture after the modified Koyanagi technique was relatively low.3.Operation success rate: Z value of the combined statistics = 2.09,P = 0.04 < 0.05,which indicates that the difference of operation success rate between modified Koyanagi technique and Duckett + Duplay technique is statistically significant,suggesting that the operation success rate of modified Koyanagi operation is higher.4.Operation time: there was no significant difference between the two groups.5.There was no significant difference in the incidence of urethra fistula between modified Koyanagi technique(reconstruction of urethra plate with "tennis racket" flap)and Duckett + Duplay technique;the incidence of urethra stenosis was lower and the success rate was higher with statistical basis;6.There was no significant difference in the incidence of Urethral fistula、stricture and the success rate of operation between The Koyanagi technique(reconstruction of urethra plate by longitudinal incision of dorsal prepuce)and Duckett + Duplay technique.Conclusions:1.Compared with Duckett + dupaly technique,modified Koyanagi technique has a lower incidence of urethral stricture and a higher success rate in the one-stage treatment of proximal hypospadias.There is no obvious evidence to suggest that there is a difference in the incidence and operation time of urethra fistula between modified Koyanagi technique and Duckett + dupaly technique in the one-stage treatment of proximal hypospadias;2.The modified Koyanagi technique and Duckett + dupaly technique are both effective surgical schemes for the one-stage treatment of proximal hypospadias.However,the operation procedure of modified Koyanagi technique is relatively simple and easier to master.3.The clinical effect of modified Koyanagi technique and Duckett + Dupaly technique in the treatment of proximal hypospadias still needs to be further verified by multi center,large sample size and high-quality randomized controlled trials.