Indian Journal of Urology
LETTER TO EDITOR
Year
: 2019  |  Volume : 35  |  Issue : 4  |  Page : 310--311

Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9


Gopal Sharma, Aditya Prakash Sharma 
 Department of Urology, PGIMER, Chandigarh, India

Correspondence Address:
Aditya Prakash Sharma
Department of Urology, PGIMER, Chandigarh
India




How to cite this article:
Sharma G, Sharma AP. Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9.Indian J Urol 2019;35:310-311


How to cite this URL:
Sharma G, Sharma AP. Re: Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9. Indian J Urol [serial online] 2019 [cited 2019 Nov 18 ];35:310-311
Available from: http://www.indianjurol.com/text.asp?2019/35/4/310/268301


Full Text

Dear Editor,

We read the article published by Goel et al.[1] titled “Does caudal analgesia increase the rates of urethrocutaneous fistula (UCF) formation after hypospadias repair? Systematic review and meta-analysis” with great interest. This article explores the effects of caudal block on outcome of hypospadias repair. Manuscript is well-written and concluded that “administration of caudal analgesia in patients undergoing hypospadias repair may be associated with a higher risk of UCF and other urethroplasty-related complications.” However, caution must be exerted while interpreting results of this study due to the inherent limitations of this review due to poor quality of studies included. Apart from limitations highlighted by authors, we would like to express certain methodological concerns regarding this study.

The search strategy used for conducting this review is not based on patient/population, intervention, control, and outcome guidelines; moreover, search strategy is not reproducible. The PRISMA guidelines recommend using PRISMA flow chart to express the strategy used for study selection which is missing in this study; instead, a table describing keywords used is provided.[2] PRISMA guidelines also recommend registration of the study protocol with PROSPERO or any other database, which is lacking from this reviewAnother important methodological concern is the method used for the assessment for risk of bias. The authors have described “The risk of bias assessment tool recommended by the GRADE working group was used to assess the quality of each study.” GRADE recommendations are for providing certainty and strength of recommendations. The tools which authors have used (wrongly mentioned as GRADE working group) is Cochrane risk of bias assessment tool,[3] which is recommended for randomized controlled trials. However, in this study, authors have used this tool for nonrandomized studies as well. Other tools such as Newcastle–Ottawa[4] or risk of bias in nonrandomized studies tools are recommended for quality assessment of nonrandomized studiesOne of the most serious and important methodological concern of this study is the use of fixed-effect model for quantitative analysis in forest plots. In the presence of significant heterogeneity, random-effect model use is recommended. Thus, this limitation by affecting the results of this study jeopardizes the validity of this study.[5] We recommend Forest plots should be redrawn after applying random-effect model.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

References

1Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019;35:222-9.
2Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 2009;339:b2535.
3Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
4Wells G, Shea B, O'Connell D, Peterson J. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses; 2014.
5Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.3.0. The Cochrane Collaboration. Available from: http://www.cochrane-handbook.org. [Last accessed on 2019 Jul 30].