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The utilization of hyperbaric oxygenation therapy in hypospadias repair: a systematic review and meta-analysis

  • Urology - Review
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Abstract

Introduction

This study aimed to evaluate the efficacy and safety of Hyperbaric Oxygen Therapy (HBOT) use in hypospadias repair through systematic review and meta-analysis of comparative studies.

Methods

A systematic literature search was performed in May 2021. Comparative studies assessing the surgical outcome of hypospadias repair between control versus HBOT utilization were identified and evaluated according to Cochrane collaboration recommendations. The assessed outcome includes hypospadias repair failures and graft failure for staged repair using a buccal graft. Relative risk with corresponding 95% confidence intervals (CI) were extrapolated. A random-effect model was used to generate pooled effect estimates. Heterogeneity and inter-study variability were assessed using Chi-square and I-square. Subgroup analysis was performed according to primary repair versus redo-hypospadias with buccal graft. PROSPERO registration (CRD42021251423).

Results

Five comparative studies with 576 cases (301 HBOT versus 275 controls) were included. Overall pooled effect estimates showed that the HBOT group has significantly lesser hypospadias repair failure (RR 0.52, 95%CI 0.37, 0.72). Subgroup analysis on the use of HBOT for graft take showed lesser graft failure compared to the control group (RR 0.20, 95% CI 0.05, 0.75), while the use of HBOT for primary and redo single staged hypospadias repair showed lesser complication rate (RR 0.56, 95%CI 0.40, 0.78). Based on ROBINS-I assessment, all included comparative studies are determined to be of serious risk of bias mainly due to presence of confounding.

Conclusion

The currently available low-quality of evidence suggests that compared to control groups, HBOT as an adjunctive intervention to complicated hypospadias repair was able to reduce surgical outcome failure and graft failure rates.

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Author information

Authors and Affiliations

  1. Global Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Michael E. Chua

  2. Division of Urology, Hospital for Sick Children, Toronto, ON, Canada

    Michael E. Chua, Justin Jin Kyu Kim, Darius J. Bagli, Mandy Rickard, Martin A. Koyle & Armando J. Lorenzo

  3. Institute of Urology, St. Luke’s Medical Center, NCR, Quezon City, Philippines

    Michael E. Chua, Mark Jason De Jesus & Manuel C. See IV

  4. Department of Surgery, University of New Mexico, Albuquerque, NM, USA

    Jessica M. Ming

Authors
  1. Michael E. Chua
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Corresponding author

Correspondence to Michael E. Chua.

Ethics declarations

Conflict of interest

Nothing to Disclose from all authors.

Research involving human participants and/or animals

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Not Applicable.

Review registration

PROSPERO (CRD42021251423).

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Appendix A

Appendix A

Database: OVID Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present Search Strategy: May 24, 2021.

  1. 1.

    Exp hypospadias/ (5118)

  2. 2.

    hypospadia*.ti,ab,kf. (6705)

  3. 3.

    (hypospadias adj2 (correction* or repair* or procedure* or modif*)).ti,ab,kf. (1902)

  4. 4.

    Or/1–3 (7569)

  5. 5.

    (hyperbar$ adj oxygen$).ti,ab. (10,220)

  6. 6.

    high pressure oxygen$.ti,ab. (229)

  7. 7.

    exp Hyperbaric Oxygenation/ (12,100)

  8. 8.

    oxygen.ti,ab,kf. (512,544)

  9. 9.

    or/5–8 (517,161)

  10. 10.

    4 AND 9 (33)

Embase Classic + Embase 1947 to 2021 May 21.

  1. 11.

    Exp hypospadias/ (11,305)

  2. 12.

    hypospadia*.ti,ab,kw. (9360)

  3. 13.

    (hypospadias adj2 (correction* or repair* or procedure* or modif*)).ti,ab,kw. (2534)

  4. 14.

    Or/1–3 (12,473)

  5. 15.

    (hyperbar$ adj oxygen$).ti,ab. (13,715)

  6. 16.

    high pressure oxygen$.ti,ab. (381)

  7. 17.

    exp Hyperbaric Oxygen/ (3462)

  8. 18.

    oxygen.ti,ab,kw. (655,432)

  9. 19.

    or/5–8 (658,264)

  10. 20.

    4 AND 9 (58)

PUBMed (13)

(“hyperbaric”[All Fields] OR “hyperbarics”[All Fields]) AND (“cell respiration”[MeSH Terms] OR (“cell”[All Fields] AND “respiration”[All Fields]) OR “cell respiration”[All Fields] OR “oxygenation”[All Fields] OR “oxygen”[MeSH Terms] OR “oxygen”[All Fields] OR “oxygen s”[All Fields] OR “oxygenate”[All Fields] OR “oxygenated”[All Fields] OR “oxygenates”[All Fields] OR “oxygenating”[All Fields] OR “oxygenations”[All Fields] OR “oxygenative”[All Fields] OR “oxygenator s”[All Fields] OR “oxygenators”[MeSH Terms] OR “oxygenators”[All Fields] OR “oxygenator”[All Fields] OR “oxygene”[All Fields] OR “oxygenic”[All Fields] OR “oxygenous”[All Fields] OR “oxygens”[All Fields]) AND (“hypospadias”[MeSH Terms] OR “hypospadias”[All Fields] OR “hypospadia”[All Fields])

Scopus (17) Proquest (10) Cochrane Library (2)

Hyperbaric AND Oxygen AND Hypospadias

Clinicaltrials.gov (0)

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Chua, M.E., Kim, J.J.K., Ming, J.M. et al. The utilization of hyperbaric oxygenation therapy in hypospadias repair: a systematic review and meta-analysis. Int Urol Nephrol 54, 273–285 (2022). https://doi.org/10.1007/s11255-021-03096-y

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