Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis

To assess postoperative oral morbidity through meta-analysis of comparative studies for closure or non-closure of the buccal mucosa graft harvest area in patients undergoing urethroplasty. A systematic literature review was conducted in January 2022. Randomized controlled studies were assessed according to the Cochrane collaboration guidelines. Postoperative pain, difficult mouth opening, alteration of oral salivation, perioral numbness, and tolerance of solid and liquid intake results were assessed. Standard mean differences and risk ratios with 95% confidence intervals were estimated for relative risk. Assessment was performed with subgroup analyses according to time points. This meta-analysis included 373 patients in 7 randomized studies. The oral pain overall pooled effect estimates were investigated for the time points of day 0–1, day 3–7 and months 1–6. According to corrected effect estimates after sensitivity analysis, at the day 0–1 time point, the non-closure group was significantly superior compared to the closure group. But there was no difference at the other time points and in total. The overall pooled effect estimates for difficult mouth opening were investigated at 4 time points (day 1, days 5–7, months 1–3 and months 6). After sensitivity analysis, the overall pooled effect estimates at 6 months were significantly superior for the non-closure group. There were no significant differences between the non-closed and closed groups based on the overall pooled-effect estimates for oral numbness, salivary secretion alteration, and tolerance of liquid and solid food variants. The non-closure group was more advantageous in terms of oral pain in the early postoperative period. There were no differences between the groups in terms of alteration of salivation, oral numbness and toleration of liquid/solid food. Although the non-closed group seems more advantageous in terms of ease in mouth movements, more studies are needed to prove this.

本研究旨在通过对尿道成形术患者颊黏膜供区缝合与不缝合的对照研究开展荟萃分析，评估术后口腔并发症发生情况。研究于2022年1月完成系统文献回顾，所有纳入的随机对照试验均严格遵循Cochrane协作网指南进行评价。本研究评估的结局指标包括术后疼痛、张口困难、唾液分泌改变、口周麻木，以及固体与流质食物的耐受情况。采用标准化均数差与风险比（95%置信区间）估计相对风险，并按时间节点进行亚组分析。本次荟萃分析共纳入7项随机对照研究，涉及373例患者。针对术后疼痛，本研究在术后0~1天、3~7天及1~6个月三个时间节点分析了其总体合并效应量；经敏感性分析校正效应量后，在术后0~1天这一时间节点，不缝合组的术后疼痛情况显著优于缝合组，但在其余时间节点及总体分析中两组未观察到显著差异。针对张口困难，本研究在术后1天、5~7天、1~3个月及6个月四个时间节点分析了其总体合并效应量；经敏感性分析后，术后6个月时不缝合组的张口困难情况显著更优。对于口周麻木、唾液分泌改变以及固体与流质食物耐受情况，两组的总体合并效应量未观察到显著差异。术后早期，不缝合组在缓解术后疼痛方面更具优势；而在唾液分泌改变、口周麻木及食物耐受情况方面，两组无显著差异。尽管不缝合组在口腔活动舒适度方面似乎更具优势，但仍需更多研究证实这一结论。