CONTEXT: Although urethral covering during @entity2650 repair minimizes the incidence of @entity292 , wide variation in results among surgeons has been reported. OBJECTIVE: To investigate what type of flap used during Snodgrass or @entity292 repair reduces the incidence of @entity292 occurrence. EVIDENCE ACQUISITION: We systematically reviewed published results for urethral covering during Snodgrass and @entity292 repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all @entity1 with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of @entity86 . EVIDENCE SYNTHESIS: A total of 51 reports were identified involving 4550 @entity1 , including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For @entity2650 , double-layer DF had the lowest rate of @entity292 incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal @entity2650 cases (9/102, 8.8%). Among repeat cases, @entity292 incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among @entity1 with @entity292 after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p=0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of @entity3832 are limitations of this study. CONCLUSION: A double DF during tubularized incised plate urethroplasty should be considered for all @entity1 with @entity2650 . In proximal, repeat, and @entity292 repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results. @entity1 SUMMARY: We systematically reviewed the impact of urethral covering in reducing @entity292 formation after @entity2650 repair. We propose an algorithm that might help to maximize success rates for tubularized incised plate urethroplasty.

Algorithm for Optimal Urethral Coverage in XXXX and Fistula Repair: A Systematic Review.

@entity1 :: ('9606', 'Species') :: ['patients', 'PATIENT'] @entity2650 :: ('MESH:D007021', 'Disease') :: ['distal hypospadias', 'hypospadias'] @entity292 :: ('MESH:D005402', 'Disease') :: ['fistula'] @entity86 :: ('MESH:D019106', 'Disease') :: ['postoperative fistula'] @entity3832 :: ('MESH:D014525', 'Disease') :: ['urethral stricture']
@entity2650 :: (MESH:D007021,Disease) :: ['Hypospadias']
