Abstract / Summary
Background/Objectives: Hypospadias is a congenital malformation where surgical treatment remains complex while complications are common. Coverage of the neourethra with various layers, such as dartos flaps, is usually part of surgical reconstruction. Coverage layers have been associated with a reduction in complications. Recently platelet-rich fibrin (PRF), a second-generation personalized autologous blood-derived product, has been used as a protective layer after being formed into a membrane. Methods: A systematic review and meta-analysis were conducted by searching the PubMed/MEDLINE and Scopus databases for relevant studies to assess differences in postoperative outcomes when using a PRF membrane as a coverage layer for hypospadias urethroplasty. Results: Eight studies were eligible. Operative time is slightly extended with PRF application (mean difference = 5.02 min, 95% CI: 2.76 to 7.29, p < 0.0001), while hospital stay appears to be equivalent. Urethral fistula (Risk Ratio (RR) = 0.55, 95% CI: 0.35 to 0.88, p = 0.01), meatal stenosis (RR = 0.41, 95% CI: 0.17 to 1.00, p = 0.05), wound infection (RR = 0.42, 95% CI: 0.17 to 1.04, p = 0.06) and bleeding rates (RR = 0.55, 95% CI: 0.12 to 2.46, p = 0.43) present favorable results when using a PRF layer. Urethral stricture risk cannot be estimated. Glans dehiscence rates appear higher when PRF membranes are used. However, heterogeneity of the literature was high and certainty of evidence was low. Conclusions: PRF layer application seems promising in reducing postoperative complication rates of hypospadias surgery, except for glans dehiscence. Standardization of PRF production, application and long-term follow-up of patients are important for future studies and strengthening the body of evidence.