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Modified versus traditional Devine procedure for pediatric concealed penis: a systematic review and meta-analysis
Jinwei Mao1, Jie Deng2, Xiqi Peng2
1Shantou University Medical College, Shantou, 515063, China.
Insights
The modified Devine procedure (MDP) is more effective and safer than the traditional Devine procedure (TDP) for treating pediatric concealed penis (CP). Further research is needed to confirm these findings for pediatric urology patients.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Congenital Abnormalities
Background:
- Concealed penis (CP) is a common congenital condition requiring surgical correction.
- The modified Devine procedure (MDP) is increasingly used, but its comparison to the traditional Devine procedure (TDP) is unclear.
Purpose of the Study:
- To compare the safety and effectiveness of the MDP versus the TDP for treating pediatric CP.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 and AMSTAR guidelines.
- Included prospective, retrospective, and randomized controlled studies comparing MDP and TDP.
- Searched five databases up to May 2025; data extracted by two independent reviewers.
- Statistical analysis using Stata 16.0, calculating WMD and OR with 95% CIs; assessed study quality with NOS and ROBINS-I.
Main Results:
- MDP demonstrated advantages over TDP in reduced length of stay, blood loss, and edema time.
- MDP showed improved postoperative penis length, extension length, and significantly fewer complications.
- Higher patient satisfaction and effectiveness were observed with MDP, with comparable operative times.
Conclusions:
- The modified Devine procedure (MDP) is superior to the traditional Devine procedure (TDP) for pediatric concealed penis treatment.
- Results indicate preliminary trends favoring MDP, but larger RCTs are necessary for validation.
- Further research is recommended to strengthen the evidence base for MDP in pediatric urology.
Background:
Concealed penis (CP) is a common congenital condition in pediatric urology, and surgical correction remains the mainstay of treatment. The modified Devine procedure (MDP) has been increasingly used, but its comparative safety and effectiveness relative to the traditional Devine procedure (TDP) remain unclear. This study aimed to compare the safety and effectiveness of the MDP with the TDP for the treatment of pediatric CP.
Methods:
This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 and AMSTAR guidelines. Prospective, retrospective, and randomized controlled studies comparing MDP and TDP for pediatric CP were included. Five databases (China National Knowledge Infrastructure, Medline, PubMed, Cochrane Library, and Web of Science) were searched from their inception to May 2025. Data extraction was performed independently by two authors, and discrepancies were resolved by a third reviewer. Statistical analyses were performed using Stata 16.0 software. Weighted mean difference (WMD) and odds ratio (OR) with 95% confidence intervals (CI) were calculated. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and ROBINS-I tool.
Results:
Twenty-two studies describing 1512 patients were included. Compared to the TDP, the MDP had an advantage in length of stay (weighted mean difference [WMD] = -1.19, 95% CI [-1.03, -0.15], p < 0.01), estimated blood loss (WMD = -4.32, 95% CI [-7.64, -1.01], p < 0.05), prepuce oedema time (WMD = -1.37, 95% CI [-2.49, -0.25], p < 0.05), postoperative penis length (WMD = 0.52, 95% CI [0.25, 0.80], p < 0.01), postoperative penis extension length (WMD = 0.90, 95% CI [0.58, 1.22], p < 0.01), complications (odds ratio [OR] = 0.15, 95% CI [0.10, 0.24), p < 0.01), prepuce oedema (OR = 0.21, 95% CI [0.13, 0.34], p < 0.01), penile retraction (OR = 0.21, 95% CI [0.06, 0.79], p < 0.05), postoperative pain (OR = 0.18, 95% CI [0.05, 0.64], p < 0.01), satisfaction (OR = 8.35, 95% CI [2.42, 28.78], p < 0.01), and effectiveness (OR = 4.64, 95% CI [2.61, 8.26], p < 0.01). The two surgical groups were comparable in terms of operative time. Several included studies had small sample sizes, and EMBASE was initially not searched due to institutional access restrictions, which may have led to the omission of relevant studies.
Conclusion:
Modified Devine procedure is superior to the traditional Devine procedure in the treatment of pediatric concealed penis. However, these results should be interpreted as preliminary trends, and further randomized controlled trials with larger sample sizes are needed to validate and strengthen these observations.
