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Effects of different implant-abutment connections on micromotion and stress distribution: prediction of microgap formation

Saidin S, Abdul Kadir MR, Sulaiman E, Abu Kasim NH

J Dent, 2012 Jun;40(6):467-74.
PMID: 22366313 DOI: 10.1016/j.jdent.2012.02.009

The aim of this study was to analyse micromotion and stress distribution at the connections of implants and four types of abutments: internal hexagonal, internal octagonal, internal conical and trilobe.

Matched MeSH terms: Algorithms
Enhanced optical flow field of left ventricular motion using quasi-Gaussian DCT filter

Riyadi S, Mustafa MM, Hussain A, Maskon O, Nor IF

Adv Exp Med Biol, 2011;696:461-9.
PMID: 21431586 DOI: 10.1007/978-1-4419-7046-6_46

Left ventricular motion estimation is very important for diagnosing cardiac abnormality. One of the popular techniques, optical flow technique, promises useful results for motion quantification. However, optical flow technique often failed to provide smooth vector field due to the complexity of cardiac motion and the presence of speckle noise. This chapter proposed a new filtering technique, called quasi-Gaussian discrete cosine transform (QGDCT)-based filter, to enhance the optical flow field for myocardial motion estimation. Even though Gaussian filter and DCT concept have been implemented in other previous researches, this filter introduces a different approach of Gaussian filter model based on high frequency properties of cosine function. The QGDCT is a customized quasi discrete Gaussian filter in which its coefficients are derived from a selected two-dimensional DCT. This filter was implemented before and after the computation of optical flow to reduce the speckle noise and to improve the flow field smoothness, respectively. The algorithm was first validated on synthetic echocardiography image that simulates a contracting myocardium motion. Subsequently, this method was also implemented on clinical echocardiography images. To evaluate the performance of the technique, several quantitative measurements such as magnitude error, angular error, and standard error of measurement are computed and analyzed. The final motion estimation results were in good agreement with the physician manual interpretation.

Matched MeSH terms: Algorithms
Microsatellite and minisatellite markers based DNA fingerprinting and genetic diversity of blast and ufra resistant genotypes

Latif MA, Rafii Yusop M, Motiur Rahman M, Bashar Talukdar MR

C. R. Biol., 2011 Apr;334(4):282-9.
PMID: 21513897 DOI: 10.1016/j.crvi.2011.02.003

A total of 78 alleles and 29 loci were detected from nine microsatellite and three minisatellite markers, respectively across 26 blast and ufra disease resistant genotypes. For blast resistant genotypes, the Polymorphic Information Content (PIC) values ranged from 0.280 to 0.726 and RM21 was considered as the best marker. PIC values ranged from 0.5953 to 0.8296 for ufra resistant genotypes and RM23 was the best marker for characterization of ufra resistant genotypes. The genetic similarity analysis using UPGMA clustering generated nine clusters with coefficient of 0.66 for blast resistant genotypes while five genetic clusters with similarity coefficient of 0.42 for ufra resistant genotypes. In order to develop resistant varieties of two major diseases of rice, hybridisation should be made using the parents, BR29 and NJ70507, BR36 and NJ70507 for blast, while BR11 and Aokazi, BR3 and Aokazi, Rayda and BR3 and Rayda and BR11 for ufra.

Matched MeSH terms: Algorithms
Wavelet neural networks applied to pulping of oil palm fronds

Zainuddin Z, Wan Daud WR, Pauline O, Shafie A

Bioresour Technol, 2011 Dec;102(23):10978-86.
PMID: 21996481 DOI: 10.1016/j.biortech.2011.09.080

In the organosolv pulping of the oil palm fronds, the influence of the operational variables of the pulping reactor (viz. cooking temperature and time, ethanol and NaOH concentration) on the properties of the resulting pulp (yield and kappa number) and paper sheets (tensile index and tear index) was investigated using a wavelet neural network model. The experimental results with error less than 0.0965 (in terms of MSE) were produced, and were then compared with those obtained from the response surface methodology. Performance assessment indicated that the neural network model possessed superior predictive ability than the polynomial model, since a very close agreement between the experimental and the predicted values was obtained.

Matched MeSH terms: Algorithms
Improved biliary detection and diagnosis through intelligent machine analysis

Logeswaran R

Comput Methods Programs Biomed, 2012 Sep;107(3):404-12.
PMID: 21194781 DOI: 10.1016/j.cmpb.2010.12.002

This paper reports on work undertaken to improve automated detection of bile ducts in magnetic resonance cholangiopancreatography (MRCP) images, with the objective of conducting preliminary classification of the images for diagnosis. The proposed I-BDeDIMA (Improved Biliary Detection and Diagnosis through Intelligent Machine Analysis) scheme is a multi-stage framework consisting of successive phases of image normalization, denoising, structure identification, object labeling, feature selection and disease classification. A combination of multiresolution wavelet, dynamic intensity thresholding, segment-based region growing, region elimination, statistical analysis and neural networks, is used in this framework to achieve good structure detection and preliminary diagnosis. Tests conducted on over 200 clinical images with known diagnosis have shown promising results of over 90% accuracy. The scheme outperforms related work in the literature, making it a viable framework for computer-aided diagnosis of biliary diseases.

Matched MeSH terms: Algorithms
Neural network diagnostic system for dengue patients risk classification

Faisal T, Taib MN, Ibrahim F

J Med Syst, 2012 Apr;36(2):661-76.
PMID: 20703665 DOI: 10.1007/s10916-010-9532-x

With the dramatic increase of the worldwide threat of dengue disease, it has been very crucial to correctly diagnose the dengue patients in order to decrease the disease severity. However, it has been a great challenge for the physicians to identify the level of risk in dengue patients due to overlapping of the medical classification criteria. Therefore, this study aims to construct a noninvasive diagnostic system to assist the physicians for classifying the risk in dengue patients. Systematic producers have been followed to develop the system. Firstly, the assessment of the significant predictors associated with the level of risk in dengue patients was carried out utilizing the statistical analyses technique. Secondly, Multilayer perceptron neural network models trained via Levenberg-Marquardt and Scaled Conjugate Gradient algorithms was employed for constructing the diagnostic system. Finally, precise tuning for the models' parameters was conducted in order to achieve the optimal performance. As a result, 9 noninvasive predictors were found to be significantly associated with the level of risk in dengue patients. By employing those predictors, 75% prediction accuracy has been achieved for classifying the risk in dengue patients using Scaled Conjugate Gradient algorithm while 70.7% prediction accuracy were achieved by using Levenberg-Marquardt algorithm.

Matched MeSH terms: Algorithms
AMI screening using linguistic fuzzy rules

Ainon RN, Bulgiba AM, Lahsasna A

J Med Syst, 2012 Apr;36(2):463-73.
PMID: 20703704 DOI: 10.1007/s10916-010-9491-2

This paper aims at identifying the factors that would help to diagnose acute myocardial infarction (AMI) using data from an electronic medical record system (EMR) and then generating structure decisions in the form of linguistic fuzzy rules to help predict and understand the outcome of the diagnosis. Since there is a tradeoff in the fuzzy system between the accuracy which measures the capability of the system to predict the diagnosis of AMI and transparency which reflects its ability to describe the symptoms-diagnosis relation in an understandable way, the proposed fuzzy rules are designed in a such a way to find an appropriate balance between these two conflicting modeling objectives using multi-objective genetic algorithms. The main advantage of the generated linguistic fuzzy rules is their ability to describe the relation between the symptoms and the outcome of the diagnosis in an understandable way, close to human thinking and this feature may help doctors to understand the decision process of the fuzzy rules.

Matched MeSH terms: Algorithms
The transcript level of interleukin-6 in the cartilage of idiopathic osteoarthritis of knee

Moktar NM, Yusof HM, Yahaya NH, Muhamad R, Das S

Clin Ter, 2010;161(1):25-8.
PMID: 20393674

AIMS: The mRNA level for interleukin-6 (IL-6) is an important marker of osteoarthritis (OA). The present study aimed to investigate the level of IL-6 mRNA in the cartilage of OA knee while comparing it to the normal cartilage obtained from the same patient.
MATERIALS AND METHODS: A total of 21 patients who underwent total knee replacement were recruited for this study. Sectioning of the destructive cartilage was performed in the medial part of the proximal tibiofemoral cartilage. The unaffected lateral part of the knee in the same patient, served as a control. The mRNA level for IL-6 was assessed using LightCycler 2.0 quantitative real-time polymerase chain reaction (qRT-PCR). actin mRNA was used as an endogenous control.
RESULTS: Twelve out of 21 patients (57.1%) exhibited up regulation of IL-6 mRNA in the OA cartilage as compared to the normal cartilage. The rest of the patients (42.9%) showed down regulation of IL-6 mRNA. The statistical analysis showed there was insignificant level of IL-6 mRNA in the OA (1.91 +/- 0.45) as compared to the normal cartilage (1.13 +/- 0.44) (p > 0.05). The inter-individual variation in the level of IL-6 mRNA in the cartilage of idiopathic knee was in accordance with previous findings.
CONCLUSIONS: These observations suggest IL-6 could also act as a catabolic agent in some patients or its expression might be influenced by other cytokines.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Matched MeSH terms: Algorithms
Utilizing shared interacting domain patterns and Gene Ontology information to improve protein-protein interaction prediction

Roslan R, Othman RM, Shah ZA, Kasim S, Asmuni H, Taliba J, et al.

Comput Biol Med, 2010 Jun;40(6):555-64.
PMID: 20417930 DOI: 10.1016/j.compbiomed.2010.03.009

Protein-protein interactions (PPIs) play a significant role in many crucial cellular operations such as metabolism, signaling and regulations. The computational methods for predicting PPIs have shown tremendous growth in recent years, but problem such as huge false positive rates has contributed to the lack of solid PPI information. We aimed at enhancing the overlap between computational predictions and experimental results in an effort to partially remove PPIs falsely predicted. The use of protein function predictor named PFP() that are based on shared interacting domain patterns is introduced in this study with the purpose of aiding the Gene Ontology Annotations (GOA). We used GOA and PFP() as agents in a filtering process to reduce false positive pairs in the computationally predicted PPI datasets. The functions predicted by PFP() were extracted from cross-species PPI data in order to assign novel functional annotations for the uncharacterized proteins and also as additional functions for those that are already characterized by the GO (Gene Ontology). The implementation of PFP() managed to increase the chances of finding matching function annotation for the first rule in the filtration process as much as 20%. To assess the capability of the proposed framework in filtering false PPIs, we applied it on the available S. cerevisiae PPIs and measured the performance in two aspects, the improvement made indicated as Signal-to-Noise Ratio (SNR) and the strength of improvement, respectively. The proposed filtering framework significantly achieved better performance than without it in both metrics.

Matched MeSH terms: Algorithms
Adsorption of copper (II), chromium (III), nickel (II) and lead (II) ions from aqueous solutions by meranti sawdust

Rafatullah M, Sulaiman O, Hashim R, Ahmad A

J Hazard Mater, 2009 Oct 30;170(2-3):969-77.
PMID: 19520510 DOI: 10.1016/j.jhazmat.2009.05.066

The present study proposed the use of meranti sawdust in the removal of Cu(II), Cr(III), Ni(II) and Pb(II) ions from synthetic aqueous solutions. Batch adsorption studies showed that meranti sawdust was able to adsorb Cu(II), Cr(III), Ni(II) and Pb(II) ions from aqueous solutions in the concentration range 1-200mg/L. The adsorption was favoured with maximum adsorption at pH 6, whereas the adsorption starts at pH 1 for all metal ions. The effects of contact time, initial concentration of metal ions, adsorbent dosage and temperature have been reported. The applicability of Langmuir, Freundlich, and Dubinin-Radushkevich (D-R) isotherm was tried for the system to completely understand the adsorption isotherm processes. The adsorption kinetics tested with pseudo-first-order and pseudo-second-order models yielded high R(2) values from 0.850 to 0.932 and from 0.991 to 0.999, respectively. The meranti sawdust was found to be cost effective and has good efficiency to remove these toxic metal ions from aqueous solution.

Matched MeSH terms: Algorithms
In silico identification and characterization of a putative phosphatidylinositol 4-phosphate 5-kinase (PIP5K) gene in Eimeria tenella

Ling KH, Loo SS, Rosli R, Shamsudin MN, Mohamed R, Wan KL

In Silico Biol. (Gedrukt), 2007;7(1):115-21.
PMID: 17688436

Phosphatidylinositol 4-phosphate 5-kinases (PIP5Ks) play diverse roles in the cellular biology of many organisms, including signal transduction, secretion and vesicular trafficking, and regulation of cytoskeleton assembly. Discovery of the PIP5K gene in Eimeria tenella may shed light on its role in the biology of this avian protozoan, and afford further understanding of the cell-host interaction, particularly during the invasion process. In this study, we report the identification of the PIP5K coding region in the genome sequence of Eimeria tenella using in silico gene prediction approaches. Prediction of the PIP5K coding sequence was confirmed by mapping the full-length cDNA sequence, generated via the Rapid Amplification of cDNA Ends (RACE) method, to the genomic sequence. The putative PIP5K gene of Eimeria tenella is located on the complementary strand of the E1080B12.b1 contig, and comprises 12 exons. Further analysis showed that the coding region spans from exon 1 to exon 7, with all exons obeying the adopted 'gt...ag' splicing rule of intronic sequences. Consensus of the hexameric 5' donor-splice site was deduced as GTRDBB... and the consensus for the 3' acceptor-splice sites as ...BHDYAG. The gene encodes a 252-amino acid residue protein. Domain search and protein fold recognition analyses provide compelling evidences that the deduced protein is a PIP5K.

Matched MeSH terms: Algorithms
Determination of skin repigmentation progression

Nugroho H, Fadzil MH, Yap VV, Norashikin S, Suraiya HH

Annu Int Conf IEEE Eng Med Biol Soc, 2007;2007:3442-5.
PMID: 18002737

In this paper, we describe an image processing scheme to analyze and determine areas of skin that have undergone repigmentation in particular, during the treatment of vitiligo. In vitiligo cases, areas of skin become pale or white due to the lack of skin pigment called melanin. Vitiligo treatment causes skin repigmentation resulting in a normal skin color. However, it is difficult to determine and quantify the amount of repigmentation visually during treatment because the repigmentation progress is slow and moreover changes in skin color can only be discerned over a longer time frame typically 6 months. Here, we develop a digital image analysis scheme that can identify and determine vitiligo skin areas and repigmentation progression on a shorter time period. The technique is based on principal component analysis and independent component analysis which converts the RGB skin image into a skin image that represent skin areas due to melanin and haemoglobin only, followed by segmentation process. Vitiligo skin lesions are identified as skin areas that lack melanin (non-melanin areas). In the initial studies of 4 patients, the method has been able to quantify repigmentation in vitiligo lesion. Hence it is now possible to determine repigmentation progression objectively and treatment efficacy on a shorter time cycle.

Matched MeSH terms: Algorithms
Clinical evaluation of watermarked medical images

Zain JM, Fauzi AM, Aziz AA

Conf Proc IEEE Eng Med Biol Soc, 2007 10 20;2006:5459-62.
PMID: 17946306

Digital watermarking medical images provides security to the images. The purpose of this study was to see whether digitally watermarked images changed clinical diagnoses when assessed by radiologists. We embedded 256 bits watermark to various medical images in the region of non-interest (RONI) and 480K bits in both region of interest (ROI) and RONI. Our results showed that watermarking medical images did not alter clinical diagnoses. In addition, there was no difference in image quality when visually assessed by the medical radiologists. We therefore concluded that digital watermarking medical images were safe in terms of preserving image quality for clinical purposes.

Matched MeSH terms: Algorithms
Quantitative assessment of breast density from digitized mammograms into Tabar's patterns

Jamal N, Ng KH, Looi LM, McLean D, Zulfiqar A, Tan SP, et al.

Phys Med Biol, 2006 Nov 21;51(22):5843-57.
PMID: 17068368

We describe a semi-automated technique for the quantitative assessment of breast density from digitized mammograms in comparison with patterns suggested by Tabar. It was developed using the MATLAB-based graphical user interface applications. It is based on an interactive thresholding method, after a short automated method that shows the fibroglandular tissue area, breast area and breast density each time new thresholds are placed on the image. The breast density is taken as a percentage of the fibroglandular tissue to the breast tissue areas. It was tested in four different ways, namely by examining: (i) correlation of the quantitative assessment results with subjective classification, (ii) classification performance using the quantitative assessment technique, (iii) interobserver agreement and (iv) intraobserver agreement. The results of the quantitative assessment correlated well (r2 = 0.92) with the subjective Tabar patterns classified by the radiologist (correctly classified 83% of digitized mammograms). The average kappa coefficient for the agreement between the readers was 0.63. This indicated moderate agreement between the three observers in classifying breast density using the quantitative assessment technique. The kappa coefficient of 0.75 for intraobserver agreement reflected good agreement between two sets of readings. The technique may be useful as a supplement to the radiologist's assessment in classifying mammograms into Tabar's pattern associated with breast cancer risk.

Matched MeSH terms: Algorithms
Hydroxyapatite nanoparticles: electrospinning and calcination of hydroxyapatite/polyvinyl butyral nanofibers and growth kinetics

Zakaria SM, Sharif Zein SH, Othman MR, Jansen JA

J Biomed Mater Res A, 2013 Jul;101(7):1977-85.
PMID: 23225849 DOI: 10.1002/jbm.a.34506

Electrospinning of hydroxyapatite (HA)/polyvinyl butyral solution resulted in the formation of fibers with average diameter of 937-1440 nm. These fibers were converted into HA nanoparticles with size <100 nm after undergoing calcination treatment at 600°C. The diameter of the fiber was found to be influenced by applied voltage and spinning distance. The injection flowrate did not affect the diameter significantly. The electrospinning method successfully reduced the commercial HA particle size in the range of 400-1100 nm into <100 nm. The dispersion of the finally calcined HA nanoparticles was improved significantly after anionic sodium dodecyl sulfate surfactant was introduced. The experimental data of HA growth kinetics were subjected to the integral method of analysis, and the rate law of the reaction was found to follow the first order reaction.

Matched MeSH terms: Algorithms
Review on CFD simulation in heart with dilated cardiomyopathy and myocardial infarction

Chan BT, Lim E, Chee KH, Abu Osman NA

Comput Biol Med, 2013 May;43(4):377-85.
PMID: 23428371 DOI: 10.1016/j.compbiomed.2013.01.013

The heart is a sophisticated functional organ that plays a crucial role in the blood circulatory system. Hemodynamics within the heart chamber can be indicative of exert cardiac health. Due to the limitations of current cardiac imaging modalities, computational fluid dynamics (CFD) have been widely used for the purposes of cardiac function assessment and heart disease diagnosis, as they provide detailed insights into the cardiac flow field. An understanding of ventricular hemodynamics and pathological severities can be gained through studies that employ the CFD method. In this research the hemodynamics of two common myocardial diseases, dilated cardiomyopathy (DCM) and myocardial infarction (MI) were investigated, during both the filling phase and the whole cardiac cycle, through a prescribed geometry and fluid structure interaction (FSI) approach. The results of the research indicated that early stage disease identification and the improvement of cardiac assisting devices and therapeutic procedures can be facilitated through the use of the CFD method.

Matched MeSH terms: Algorithms
Body surface area measurement and soft clustering for PASI area assessment

Hani AF, Prakasa E, Nugroho H, Affandi AM, Hussein SH

Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:4398-401.
PMID: 23366902 DOI: 10.1109/EMBC.2012.6346941

Psoriasis is a common skin disorder with a prevalence of 0.6 - 4.8% around the world. The most common is plaques psoriasis and it appears as red scaling plaques. Psoriasis is incurable but treatable in a long term treatment. Although PASI (Psoriasis Area and Severity Index) scoring is recognised as gold standard for psoriasis assessment, this method is still influenced by inter and intra-rater variation. An imaging and analysis system called α-PASI is developed to perform PASI scoring objectively. Percentage of lesion area to the body surface area is one of PASI parameter. In this paper, enhanced imaging methods are developed to improve the determination of body surface area (BSA) and lesion area. BSA determination method has been validated on medical mannequin. BSA accuracies obtained at four body regions are 97.80% (lower limb), 92.41% (trunk), 87.72% (upper limb), and 83.82% (head). By applying fuzzy c-means clustering algorithm, the membership functions of lesions area for PASI area scoring have been determined. Performance of scoring result has been tested with double assessment by α-PASI area algorithm on body region images from 46 patients. Kappa coefficients for α-PASI system are greater than or equal to 0.72 for all body regions (Head - 0.76, Upper limb - 0.81, Trunk - 0.85, Lower limb - 0.72). The overall kappa coefficient for the α-PASI area is 0.80 that can be categorised as substantial agreement. This shows that the α-PASI area system has a high reliability and can be used in psoriasis area assessment.

Matched MeSH terms: Algorithms
Treatment of chronic hepatitis C in patients with renal disease

Gane E

Med J Malaysia, 2005 Jul;60 Suppl B:72-6.
PMID: 16108179
Matched MeSH terms: Algorithms
Fulltext Genetic Diversity, Natural Selection and Haplotype Grouping of Plasmodium knowlesi Gamma Protein Region II (PkγRII): Comparison with the Duffy Binding Protein (PkDBPαRII)

Fong MY, Rashdi SA, Yusof R, Lau YL

PLoS One, 2016;11(5):e0155627.
PMID: 27195821 DOI: 10.1371/journal.pone.0155627

BACKGROUND: Plasmodium knowlesi is a simian malaria parasite that has been reported to cause malaria in humans in Southeast Asia. This parasite invades the erythrocytes of humans and of its natural host, the macaque Macaca fascicularis, via interaction between the Duffy binding protein region II (PkDBPαRII) and the Duffy antigen receptor on the host erythrocytes. In contrast, the P. knowlesi gamma protein region II (PkγRII) is not involved in the invasion of P. knowlesi into humans. PkγRII, however, mediates the invasion of P. knowlesi into the erythrocytes of M. mulata, a non-natural host of P. knowlesi via a hitherto unknown receptor. The haplotypes of PkDBPαRII in P. knowlesi isolates from Peninsular Malaysia and North Borneo have been shown to be genetically distinct and geographically clustered. Also, the PkDBPαRII was observed to be undergoing purifying (negative) selection. The present study aimed to determine whether similar phenomena occur in PkγRII.
METHODS: Blood samples from 78 knowlesi malaria patients were used. Forty-eight of the samples were from Peninsular Malaysia, and 30 were from Malaysia Borneo. The genomic DNA of the samples was extracted and used as template for the PCR amplification of the PkγRII. The PCR product was cloned and sequenced. The sequences obtained were analysed for genetic diversity and natural selection using MEGA6 and DnaSP (version 5.10.00) programmes. Genetic differentiation between the PkγRII of Peninsular Malaysia and North Borneo isolates was estimated using the Wright's FST fixation index in DnaSP (version 5.10.00). Haplotype analysis was carried out using the Median-Joining approach in NETWORK (version 4.6.1.3).
RESULTS: A total of 78 PkγRII sequences was obtained. Comparative analysis showed that the PkγRII have similar range of haplotype (Hd) and nucleotide diversity (π) with that of PkDBPαRII. Other similarities between PkγRII and PkDBPαRII include undergoing purifying (negative) selection, geographical clustering of haplotypes, and high inter-population genetic differentiation (FST index). The main differences between PkγRII and PkDBPαRII include length polymorphism and no departure from neutrality (as measured by Tajima's D statistics) in the PkγRII.
CONCLUSION: Despite the biological difference between PkγRII and PkDBPαRII, both generally have similar genetic diversity level, natural selection, geographical haplotype clustering and inter-population genetic differentiation index.

Matched MeSH terms: Algorithms
Algorithm for Optimal Urethral Coverage in Hypospadias and Fistula Repair: A Systematic Review

Fahmy O, Khairul-Asri MG, Schwentner C, Schubert T, Stenzl A, Zahran MH, et al.

Eur Urol, 2016 08;70(2):293-8.
PMID: 26776935 DOI: 10.1016/j.eururo.2015.12.047

CONTEXT: Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported.
OBJECTIVE: To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence.
EVIDENCE ACQUISITION: We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula.
EVIDENCE SYNTHESIS: A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p=0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p=0.020). Among patients with fistula after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p=0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of urethral stricture are limitations of this study.
CONCLUSION: A double DF during tubularized incised plate urethroplasty should be considered for all patients with distal hypospadias. In proximal, repeat, and fistula repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results.
PATIENT SUMMARY: We systematically reviewed the impact of urethral covering in reducing fistula formation after hypospadias repair. We propose an algorithm that might help to maximize success rates for tubularized incised plate urethroplasty.

Matched MeSH terms: Algorithms

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