The efficacy and safety of autologous platelet concentrates in primary hypospadias repair: a systematic review and meta-analysis of randomized controlled trials

Background Healing complications remain a significant concern following hypospadias repair, with urethrocutaneous fistula/UCF being the most prevalent, occurring in up to 25% of cases. Autologous platelet concentrates/APCs, including platelet-rich plasma/PRP and platelet-rich fibrin/PRF, are known to provide a mechanical barrier and promote tissue regeneration across various surgical disciplines. Based on these findings, APCs may enhance neourethral healing and improve overall surgical outcomes. This meta-analysis evaluates the efficacy and safety of APCs in primary hypospadias repair.Methods A systematic search was conducted across PubMed, ScienceDirect, Google Scholar, and the Cochrane Library through March 2026. Only randomized controlled trials (RCTs) involving pediatric patients undergoing primary repair with APC versus standard techniques were included. The protocol was registered in PROSPERO (CRD420261348610).Results Eight RCTs involving 713 patients (337 APCs vs 376 Control) met the eligibility criteria. The pooled analysis demonstrated that APCs application significantly reduced the incidence of UCF compared to the control group (OR 0.44; 95% CI: 0.28–0.67; p = 0.0002) (I2 = 7%; p = 0.37). Secondary outcomes indicated a concurrent reduction in wound infection and meatal stenosis rates in the APCs group. There was no significant operating time duration between APCs group and control. None of the studies reported any Severe Adverse Events (SAEs).Conclusion The use of autologous platelet concentrates as an interpositional layer significantly decreases the risk of fistula formation in primary hypospadias repair, also wound infection, and meatal stenosis rates. APCs are a safe and effective biological adjunct that should be considered to improve surgical outcomes in hypospadias repair.