Modified versus traditional Devine procedure for pediatric concealed penis: a systematic review and meta-analysis

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.

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.

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.

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.