title: Outcomes in distal hypospadias: a systematic review of the Mathieu and tubularized incised plate repairs.
abstract: OBJECTIVE
  To compare complication rates after distal hypospadias surgery using the tubularized incised plate (TIP) and Mathieu techniques.
  
  
  METHODS
  For this meta-analysis, the Medline (1990-2009), Embase (1990-2009) and Cochrane databases were searched using the keyword 'hypospadias'. Inclusion criteria were: i) primary repairs; ii) distal hypospadias; iii) paediatric case series; iv) standard Mathieu and TIP techniques; v) complication data obtainable from the paper. Cases were only included in the denominator for each complication if explicitly identified in the paper. Fisher's exact was used for statistical analysis, with P < 0.05 considered significant.
  
  
  RESULTS
  129 papers were selected for full analysis; 23 papers met the inclusion criteria comprising 1872 TIP repairs and 1496 Mathieu repairs. We identified an increased incidence of urethral fistulae with the Mathieu technique (3.8% vs 5.3%, P = 0.028); however, this is lost on subgroup analysis. An increased incidence of meatal stenosis was identified in the TIP group (3.1% vs 0.7%, P < 0.001).
  
  
  CONCLUSIONS
  There is no clear consensus on the ideal method of repair for distal hypospadias. Both the Mathieu and TIP techniques have been shown to have low rates of postoperative complications. Comparison between series is difficult because of a lack of consistency in reporting complications and follow up. We advocate uniform standards for reporting outcomes of hypospadias.
authors.affiliation: Department of Paediatric Surgery, Alder Hey Children's Hospital, NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilkinson
authors.forename: Paul
authors.initials: P
authors.lastname: Farrelly
authors.forename: Simon E
authors.initials: SE
authors.lastname: Kenny
mesh_terms: D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*