Publication Bias in Randomized Controlled Trials of Hypospadias Surgical Repair: A Systematic Review

• Published in: International journal of urology
• Main Authors: Nainggolan, Ebram, Wahyudi, Irfan, Rodjani, Arry, Situmorang, Gerhard Reinaldi, Chowdhury, Muhammad E. H., Raharja, Putu Angga Risky, Abbas, Tariq
• Format: Journal Article
• Language: English
• Published: Australia 16.06.2025
• Subjects: hypospadias; randomized clinical trials; publication bias; funnel plot; Egger's test
• ISSN: 0919-8172; 1442-2042; 1442-2042
• DOI: 10.1111/iju.70153

Hypospadias is a common congenital condition in males that has been subject to extensive research. However, publication bias can distort the scientific literature and impact clinical decision-making. This review evaluates publication bias in hypospadias research and emphasizes the need for balanced reporting to improve clinical practices and enhance patient care. A literature search was conducted using four public databases to identify peer-reviewed randomized controlled trials (RCT) of surgical interventions for hypospadias. The primary outcomes were success rate and complication rate. We assessed the publications using the Risk of Bias 2 (RoB-2) tool and evaluated the quality of evidence using the GRADE method. Data were collated and recalculated using RevMan version 5.4. Publication bias was evaluated using a funnel plot and Egger's test. The study included 32 articles for detailed analysis. The standard of evidence varied, with 8 studies rated as low quality, 23 as moderate, and 1 as high. Most studies lacked details on randomization, allocation concealment, and blinding, thus raising bias concerns. The funnel plot revealed a symmetrical distribution, and Egger's test indicated mild evidence of publication bias (p = 0.055). This study found no significant publication bias in hypospadias research, indicating a balanced evidence base at present. However, future studies should monitor bias through longitudinal assessments, explore new methodologies to mitigate bias, and increase visibility and accessibility of results to ensure the reliability of research findings.