Objective:

To evaluate and compare the efficacy of different preoperative hormonal therapies for preventing postoperative complications after hypospadias repair in pediatric patients.

Approach:

• Search Strategy: Systematic search of PubMed, Web of Science, Cochrane Library, and CNKI from inception to March 15, 2026.
• Inclusion Criteria: Randomized controlled trials (RCTs) enrolling pediatric patients with hypospadias who received preoperative hormone therapy.
• Outcome Assessment: Primary outcomes included postoperative urethrocutaneous fistula, glans dehiscence, and meatal stenosis.
• Analysis Method: Bayesian network meta-analysis using the gemtc package in R 4.3.1 and SUCRA for ranking intervention efficacy.

Key Findings:

• Androgen therapy reduced the odds of urethrocutaneous fistula (pooled OR = 0.474; 95% CI: 0.241–0.934; P = 0.031).
• In sensitivity analysis for distal hypospadias, the protective trend for fistula persisted but was not statistically significant (OR = 0.613; 95% CI: 0.285–1.319).
• No significant benefit of androgen was observed for glans dehiscence or meatal stenosis.
• Estrogen did not significantly reduce any complication.
• SUCRA analysis identified androgen as the most probable effective intervention for fistula prevention.

Interpretation:

Preoperative androgen therapy may reduce the odds of postoperative urethrocutaneous fistula in pediatric patients undergoing hypospadias repair.

Limitations:

• The benefit of androgen therapy for fistula was primarily observed in mixed-severity cohorts.
• No significant protective effect was demonstrated for glans dehiscence or meatal stenosis.

Conclusion:

Preoperative androgen therapy may reduce the odds of postoperative urethrocutaneous fistula in pediatric patients undergoing hypospadias repair.

Sources:

• Systematic Review Registration