Can sealing promote healing?: A systematic review and meta-analysis highlighting the adjunctive role of tissue sealant application during urethroplasty for hypospadias

A significant proportion of children require multiple surgeries for successful repair of hypospadias. This is not only a source of a financial burden to the family but also causes long-term social and psychosexual issues. Tissue sealant application can provide additional coverage to the suture line and subsequently prevents operative failure. However, a consensus statement regarding its usage during urethroplasty is lacking. This systematic review and meta-analysis aims to compare the outcomes of hypospadias surgery, in terms of its complications, in children with and without tissue sealant application. The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through September 2020. The occurrence of overall complications, and specific complications (including urethrocutaneous fistula, wound-related complications, flap-related complications, complications involving the neo-urethral tube and meatal stenosis) were the primary and secondary outcomes, respectively. Statistical analysis was performed using a random-effects model, and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale. Four comparative studies were included in the meta-analysis. The different types of tissue sealants such as fibrin glue, cyanoacrylate glue, BioGlue and cryocalcium glue were used in these studies. As compared to without sealant application, hypospadias repair performed with sealant application showed no significant difference in the incidence of overall postoperative complications (RR 0.63; 95% CI 0.34–1.14, p = 0.13). However, a significant reduction in some specific complications including urethrocutaneous fistula (RR 0.37; 95% CI 0.19–0.72, p = 0.003), wound-related complications (RR 0.57; 95% CI 0.38–0.86, p = 0.008) and complications involving the neo-urethra (RR 0.15; 95% CI 0.04–0.54, p = 0.004) was observed with sealant usage. The average Downs and Black scale scores ranged from 16 to 18, with all studies having a moderate risk of bias. Kappa statistics showed a value of 0.962 (p