Outcomes in distal hypospadias: A systematic review of the Mathieu and tubularized incised plate repairs David J. Wilkinson * ,1 , Paul Farrelly 1 , Simon E. Kenny Department of Paediatric Surgery, Alder Hey Children’s Hospital, NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom Received 4 August 2010; accepted 19 November 2010 Available online 14 December 2010 KEYWORDS Distal Hypospadias; Outcomes; Systematic review Abstract Aim: To compare complication rates after distal hypospadias surgery using the tu- bularized incised plate (TIP) and Mathieu techniques. Methods: For this meta-analysis, the Medline (1990e2009), Embase (1990e2009) 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 tech- niques; 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. Main 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 Z 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 re- porting complications and follow up. We advocate uniform standards for reporting outcomes of hypospadias. ª 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. Introduction Hypospadias is one of the most common congenital condi- tions affecting males worldwide. Over 200 different repairs are described in the available literature although two repairs, the tubularized incised plate (TIP) repair and the * Corresponding author. Tel.: þ151 228 4823; fax: þ151 252 5677. E-mail addresses: d.wilkinson1@mac.com (D.J. Wilkinson), pjfarrelly@googlemail.com (P. Farrelly), simon.kenny@alderhey. nhs.uk (S.E. Kenny). 1 Authors DW and PF are joint first authors and contributed equally to the paper. Journal of Pediatric Urology (2012) 8, 307e312 1477-5131/$36 ª 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jpurol.2010.11.008