Evaluation of the Clinical Efficacy of Tissue-Engineered Grafts in Urethral Reconstruction: A Systematic Review and Meta-Analysis

Introduction: The principal purpose of this study was to investigate the clinical outcomes of urethral reconstruction using tissue-engineered grafts.Methods: We searched PubMed/MEDLINE, Scopus, Embase and Web of Science until January ۱st, ۲۰۲۶. Considering the eligibility criteria, two researchers selected the articles independently. We collected data on the patient demographic data and study characteristics. We used STATA version ۱۷.۰ and R version ۴.۳.۳ to reach pooled measures. In order to assess heterogeneity between studies, I۲ were used. In order to look for the source of the statistical heterogeneity we implemented meta-regression analysis and sensitivity analysis was used to check the robustness of the results.Results: We found ۶۳۵ studies which ۷۳ of them were potentially relevant. six articles that met the inclusion criteria was added in the review. The pooled success rate of tissue-engineered urethroplasty was ۰.۷۱ (۹۵% CI: ۰.۶۵–۰.۷۷; P-value< ۰.۰۰۱, with no significant heterogeneity (I²=۰.۰%). The pooled mean postoperative Qmax was ۲۱.۱۴ mL/s (۹۵% CI: ۱۸.۶۷–۲۳.۶۲; v P-value<۰.۰۰۱), with substantial heterogeneity (I²=۷۴.۹۱%). The pooled mean improvement in Qmax was ۱۴.۸۱ mL/s (۹۵% CI: ۱۳.۲۹–۱۶.۳۲; P-value<۰.۰۰۱), with moderate heterogeneity (I²=۵۶.۲۱%). Meta-regression analyses showed that median age, follow-up duration, and stricture length were not significantly associated with the pooled outcomes. All included studies were had overall critical risk of bias. Egger’s test suggested potential publication bias for the success rate (P-value=۰.۰۲), but not for postoperative Qmax (P-value=۰.۴۴۸) or Qmax change (P-value=۰.۶۲۲). Sensitivity analysis confirmed the robustness of our findings.Conclusion: Preliminary evidence suggests that tissue-engineered grafts for urethroplasty are feasible and may provide functional improvement in selected patients. However, all included studies were small and without control groups which substantially limits the certainty and generalizability of our findings. Well-designed comparative trials with standardized outcome reporting are required before the clinical role of tissue-engineered grafts can be clearly defined.

کلیدواژه ها:

Urethral stricture ، Urethroplasty ، Buccal Mucosal Graft ، Tissue-Engineering ، Systematic review ، Meta-analysis