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Oxygen-rich dressing for hypospadias repair: Systematic review and meta-analysis
Marilyn Wong1, Fabio Botelho1, Michael E Chua1,2
1The Hospital for Sick Children, Division of Urology, Toronto, ON, Canada.
Introduction:
Postoperative dressing selection after hypospadias repair varies widely and is largely guided by surgeon preference. Oxygen-enriched and ozone-based topical dressings have demonstrated antimicrobial and wound-healing benefits in other settings, but their role after hypospadias repair remains unclear. We performed a systematic review and meta-analysis to evaluate outcomes associated with oxygen-rich or ozone-based dressings compared with standard postoperative care.
Methods:
We searched CENTRAL, CINAHL, Embase, MEDLINE, PubMed, Scopus, Google Scholar, and trial registries from inception to July 31, 2025, for clinical studies comparing oxygen- or ozone-based dressings with standard postoperative care. Hyperbaric oxygen therapy, abstracts without full-text, and basic science studies were excluded. Two reviewers independently screened studies and assessed risk of bias using RoB 2. Random-effects meta-analyses were performed using mean differences (MD) and risk ratios (RR).
Results:
Of 594 records identified, three randomized controlled trials met inclusion criteria, comprising 264 children undergoing primary distal hypospadias repair. All studies had some concerns or high risk of bias, mainly due to lack of preregistration and incomplete blinding of subjective outcomes. Compared with standard dressings, oxygen- or ozone-based dressings were associated with shorter wound-healing time (MD -9.80 days, 95% confidence interval [CI] -15.85 to -3.75, I2=89%) and fewer reoperations (relative risk [RR] 0.24, 95% CI 0.07-0.75, I2=0%). Differences in foreskin dehiscence, wound infection, and urethrocutaneous fistula were not statistically significant.
Conclusions:
Limited randomized evidence suggests oxygen-rich or ozone-based dressings may improve early healing and reduce reoperations after distal hypospadias repair, while no statistically significant differences were observed for individual complications. Larger, methodologically rigorous trials are needed before routine adoption can be recommended.
