Interrupted vs. continuous suture urethroplasty in tubularised incised plate hypospadias: an updated systematic...

The optimal suturing technique for urethral tubularisation during tubularised incised plate (TIP) urethroplasty remains debated. This systematic review and meta-analysis compared perioperative and postoperative outcomes of interrupted versus continuous suturing techniques in paediatric hypospadias repair.

A systematic literature search was performed in PubMed, Cochrane Library, Embase, Scopus, and ClinicalTrials.gov from inception to December 2025 in accordance with PRISMA guidelines. Randomised controlled trials and observational studies comparing interrupted and continuous suturing during paediatric TIP urethroplasty were included. Outcomes assessed were urethrocutaneous fistula, surgical site infection, meatal stenosis, urethral stricture, glans dehiscence, overall complications, urinary stream outcomes, operative time, and reoperation rates. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool and the ROBINS-I. A random-effects meta-analysis supplemented by influence diagnostics and Hartung-Knapp adjustment for heterogeneous outcomes, were conducted using R version 4.5.2, with results expressed as odds ratios (ORs) or mean differences (MDs) and corresponding 95% confidence intervals (CIs).

Fifteen studies involving 2625 paediatric patients were included, with 800 undergoing interrupted suturing and 1,825 continuous suturing. No statistically significant differences were observed between techniques for urethrocutaneous fistula (OR 0.65, 95% CI 0.38-1.11), surgical site infection (OR 0.61, 95% CI 0.25-1.48), meatal stenosis (OR 0.98, 95% CI 0.54-1.80), urethral stricture (OR 1.08, 95% CI 0.29-3.97), overall complications (OR 0.75, 95% CI 0.48-1.17), or glans dehiscence (OR 0.77, 95% CI 0.36-1.63). Operating time showed no clinically meaningful difference operative time (MD 3.77 min, 95% CI - 3.69 to 11.24, Hartung-Knapp adjusted).

Continuous and interrupted suturing techniques during TIP urethroplasty demonstrate comparable complication rates and functional outcomes. These findings suggest that suturing technique may be selected based on surgeon preference and experience; however, large, well-designed multicentre randomised trials are required to further inform clinical practice.