Foreskin Reconstruction or Conventional Circumcision in Hypospadias: A Systematic Review and Meta-analysis

Hypospadias is a common congenital anomaly of the male genitalia requiring surgical correction. During hypospadias repair, there are two broad approaches to deal with prepuce-foreskin reconstruction (FR) and conventional circumcision (CC). While FR preserves and reshapes the dorsal prepuce to mimic the normal appearance, CC involves excision or rearrangement of the prepuce leading to a circumcised appearance. The choice between these techniques is influenced by cultural, religious, and personal preferences; the techniques themselves differ in surgical complexity and complication risks. This systematic review and meta-analysis compares FR and CC in hypospadias repair focussing on surgical outcomes and complications. A comprehensive search of relevant randomized controlled trials and prospective studies were performed across PubMed, Embase, Scopus, and Cochrane Library. Studies were assessed for risk of bias using ROB-2 and ROBINS-I tools. Primary outcomes included urethra-cutaneous fistula (UCF), meatal stenosis (MS), and glans dehiscence (GD). Secondary outcomes included preputial complications and operative time. Both FR and CC yield comparable results in terms of major complications such as UCF, MS, and GD. Operative time shows variability, with no clear difference between the groups. However, FR carries a higher risk of preputial complications.