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Network meta-analysis of different preoperative hormone therapies for improving postoperative complications in
Ling Wu1, Wenmei Wang1, Qi Zhao1
1Department of Pediatric Surgery, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Insights
Preoperative androgen therapy may lower the risk of urethrocutaneous fistula after hypospadias repair in children. However, it did not significantly reduce other complications like glans dehiscence or meatal stenosis.
Area of Science:
- Pediatric Urology
- Surgical Complications
- Endocrinology
Background:
- Hypospadias repair is a common pediatric urological surgery.
- Postoperative complications can negatively impact outcomes.
- Preoperative hormonal therapy is explored to mitigate these risks.
Purpose of the Study:
- To systematically review and compare the efficacy of preoperative hormonal therapies.
- To evaluate their role in preventing complications after hypospadias repair in pediatric patients.
- To conduct a network meta-analysis of relevant randomized controlled trials (RCTs).
Main Methods:
- Systematic literature search across major databases (PubMed, Web of Science, Cochrane Library, CNKI) up to March 2026.
- Inclusion of RCTs involving pediatric patients with hypospadias receiving preoperative hormone therapy.
- Bayesian network meta-analysis using R, with risk of bias assessment and sensitivity analyses.
Main Results:
- Six RCTs (715 patients) were analyzed.
- Androgen therapy showed a significant reduction in urethrocutaneous fistula odds (OR=0.474, P=0.031) in mixed cohorts.
- No significant benefits were found for glans dehiscence, meatal stenosis, or with estrogen therapy.
Conclusions:
- Preoperative androgen therapy may offer a protective effect against urethrocutaneous fistula in hypospadias repair.
- Evidence for preventing other complications is limited.
- Further high-quality RCTs are needed, especially for distal hypospadias.
Objective:
To evaluate and compare the efficacy of different preoperative hormonal therapies for preventing postoperative complications after hypospadias repair in pediatric patients through a systematic review and network meta-analysis.
Methods:
PubMed, Web of Science, Cochrane Library, and CNKI were systematically searched (inception to March 15, 2026). Randomized controlled trials (RCTs) enrolling pediatric patients with hypospadias who received preoperative hormone therapy were included. Risk of bias was assessed using the Cochrane RoB 2 tool. The primary outcomes were postoperative urethrocutaneous fistula, glans dehiscence, and meatal stenosis. Bayesian network meta-analysis was performed using the gemtc package in R 4.3.1, and SUCRA was used to rank intervention efficacy. Sensitivity analysis excluding non-distal cohorts was performed to assess robustness.
Results:
Six RCTs (715 patients) were included. Direct pairwise meta-analysis showed that androgen therapy reduced the odds of urethrocutaneous fistula (pooled OR = 0.474; 95% CI: 0.241-0.934; P = 0.031). In the sensitivity analysis restricted to distal hypospadias only, the protective trend persisted but did not reach statistical significance (OR = 0.613; 95% CI: 0.285-1.319). No significant benefit of androgen was observed for glans dehiscence or meatal stenosis. Estrogen did not significantly reduce any complication. SUCRA analysis identified androgen as the most probable effective intervention for fistula prevention.
Conclusion:
Preoperative androgen therapy may reduce the odds of postoperative urethrocutaneous fistula in pediatric patients undergoing hypospadias repair, though this benefit was primarily observed in mixed-severity cohorts. No significant protective effect was demonstrated for glans dehiscence or meatal stenosis. Further high-quality RCTs with standardized protocols and long-term follow-up are warranted, particularly in distal hypospadias populations.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261351057, identifier CRD420261351057.
