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Elnashar AM, Albishbishy M, Sheir H, Elayyouti M, Elsherbiny M, Elzohiri M, Ghazaly Waly ME, Elsaied A. Comparative Study Between Autologous Platelet-rich Fibrin Membrane and Local Flaps as Intervening Layer in Management of Distal Hypospadias. J Pediatr Surg 2025; 60:161994. [PMID: 39461004 DOI: 10.1016/j.jpedsurg.2024.161994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 07/25/2024] [Revised: 09/26/2024] [Accepted: 10/02/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND/PURPOSE The most frequent complication following hypospadias correction is fistula formation. Recently, fibrin glue has been employed as a 2nd layer covering the urethroplasty resulting in a reduction in the incidence of fistulas. Platelet-rich fibrin (PRF) is an autologous growth factor-rich source. Although the authors recommend the use of additional layers in hypospadias correction, there remains a controversy. In a trial to address this issue, our research was conducted to compare the accessibility of urethroplasty coverage using PRF to traditional local flaps, aiming to prevent fistula formation in hypospadias repair. PATIENTS AND METHODS This is a prospective single-blinded randomized controlled study that involved 60 hypospadias cases admitted to Mansoura University Children Hospital's Pediatric Surgery department between March 2021 and March 2023. These 60 cases were randomly divided into 2 equal groups: (group A platelet-rich fibrin coverage membrane & group B local dartos flap as an additional layer). Both groups were compared regarding the rate of complications. All cases were evaluated regarding age at repair, type of hypospadias, urethral plate width, length of urethroplasty, and size of the 2nd layer. The blood loss and operative time were documented and post-operatively; the cases were assessed for the repair intactness, shape, and size of the neo-meatus, existence of any post-operative problems such as urethral fistula, urethral stricture, meatal stenosis, failure of the repair, or diverticulum. Statistical analysis was carried out following data collection. RESULTS The median length of the 2nd layer in group A was 20 mm (range 15-23 mm) and in group B was 22.5 mm (range 19.5-25 mm) and the difference between the two groups was statistically significant (p = 0.012∗), while its median width in group A was 10 mm (range 10-11 mm) and in group B was 15 mm (range 10-18 mm) and also there was statistically significant difference (p = 0.001∗). The mean operative time in group A was 95.73 ± 11.9 min and in group B was 102.33 ± 10.32 min and there was a statistically significant difference (P < 0.001). The length of hospital stay in group A was 5.47 ± 1.11 days and in group B was 5.47 ± 0.89 days. The urethral fistula was detected in 4 cases of group A (13.3%) and 3 cases of group B (10%). The failure of repair was similar, one case of each group (3.3%). The meatal stenosis was reported in only one case of group A (3.4%) and 7 cases of group B (24.1%) (P = 0.02∗) and the difference was statistically significant. There were no reports of urethral strictures among the cases in either group over the follow-up period (mean 9 months, range 5-17 months). CONCLUSION PRF patch may be employed as a coverage layer over the urethroplasty in repair of the distal hypospadias, especially in cases without accessible vascular flap with comparable outcome to traditional local flaps. TYPE OF STUDY A prospective single blinded randomized controlled trial (computer-generated numbers method). LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Ahmed M Elnashar
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Mohammed Albishbishy
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hesham Sheir
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Moustafa Elayyouti
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elsherbiny
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elzohiri
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M El Ghazaly Waly
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adham Elsaied
- Mansoura University Children Hospital, Pediatric Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Wishahy AMK, Abdullateef KSA, Kaddah SN, Mohamed AA, Mohamed MT. Surgical Evaluation of Autologous Platelet-rich Fibrin Membrane as a Coverage Layer in Repair of Urethrocutaneous Fistula after Hypospadias Surgeries: A Randomized Controlled Trial. J Indian Assoc Pediatr Surg 2024; 29:505-510. [PMID: 39479420 PMCID: PMC11521221 DOI: 10.4103/jiaps.jiaps_149_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/18/2022] [Revised: 03/30/2024] [Accepted: 04/15/2024] [Indexed: 11/02/2024] Open
Abstract
Purpose It has recently been reported that the use of platelet-rich fibrin (PRF) as an extralayer over the urethroplasty has been related to a considerable reduction in fistula rates. Due to the lack of evidence supporting the usage of PRF in urethrocutaneous fistula (UCF) repair, we conducted this study to evaluate the efficacy of PRF in patients with UCF. Materials and Methods We conducted a randomized controlled study on patients with distal fistula after hypospadias repair. Patients were randomized into two groups, one with local dartos coverage and the other with PRF coverage layer. Results In the present study, we included 37 patients; 20 patients underwent local dartos coverage, and 17 patients underwent PRF. The mean age was 22.45 ± 4545 ± 4515 ± ±15.35 (range 11-56) months for the study group and 20.6 ± 66 ± 614 ± ±14.5 (range 6-45) months for the control group. The incidence of recurrent UCF was 11.8% in the treatment group (two patients), whereas the incidence was 30% (six patients) in the control group (P = 0.246). Conclusion UCF surgery may benefit from the use of PRF as a supportive tissue that promotes wound healing, angiogenesis, and tissue restoration. We believe that the use of PRF as a new approach for UCF repair should be investigated further through clinical studies.
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Siregar S, Steven S, Mustafa A. The benefit of tissue sealant on urethroplasty in hypospadias patients - A systematic review and meta-analysis. F1000Res 2024; 11:184. [PMID: 38974407 PMCID: PMC11226945 DOI: 10.12688/f1000research.108503.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Accepted: 01/15/2024] [Indexed: 07/09/2024] Open
Abstract
Background Hypospadias was ranked second after undescended testis as the most prevalent congenital abnormality in newborn males. Hypospadias can be successfully repaired through multiple surgeries in the majority of children. Postoperative complications were not rarely seen after surgeries, such as urethrocutaneous fistula (UCF), meatal stenosis, and glans breakdown. Tissue sealant application in hypospadias repair serves as additional suture line coverage and reduces the post surgery complications. However, the effects of sealants usage during urethroplasty are still uncertain. This review aimed to know the effects of tissue sealant usage on patients with hypospadias who undergo urethroplasty. Methods The study was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature was searched on PubMed, Embase, and Scopus following PRISMA guidelines. The search was conducted on October 12th, 2021, using the search term ("glue" OR "sealants" OR "tissue glue" OR "tissue sealant" OR "tissue adhesive") AND ("hypospadias" OR "urethrocutaneous fistula" OR "urethral repair" OR "urethroplasty" OR "hypospadiology"). Result Systematic searching from all databases resulted in 160 potential articles. After a full-text review, eight articles were included in this study. Urethrocytaneous fistula complication was reported in all studies. The occurrence of complication reported by all studies was urethrocutaneous fistula. Several studies also reported tissue edema and flap-related complications. Tissue sealant had no significant effect in reducing meatal stenosis. Conclusions This systematic review revealed additional benefits from several types of tissue sealant in hypospadias repair surgery. Fibrin sealant application over the urethroplasty suture line in hypospadias repair offers a water-proof coverage and may enhance the outcome from the surgery.
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Affiliation(s)
- Safendra Siregar
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Steven Steven
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
| | - Akhmad Mustafa
- Urology department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, West Java, 40161, Indonesia
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Moran GW, Kurtzman JT, Carpenter CP. Biologic adjuvant urethral coverings for single-stage primary hypospadias repairs: A systematic review and pooled proportional meta-analysis of postoperative urethrocutaneous fistulas. J Pediatr Urol 2022; 18:598-608. [PMID: 36085187 DOI: 10.1016/j.jpurol.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of barrier layers between the neourethra and skin is associated with lower rates of post-operative urethrocutaneous fistula (UCF) following hypospadias surgery. Recent studies have evaluated the ability of biologic adjuvant urethral coverings (BAUCs) - namely acellular matrix (AM), tissue adhesives (TAs), and autologous platelet-rich plasma or fibrin (PRP/PRF) - to prevent wound complications following hypospadias surgery. In general, however, these studies are small and conducted at single institutions. OBJECTIVE To assess the effect of BAUCs on the rate of UCF following single-stage primary hypospadias repair. METHODS We conducted a systematic review of studies reporting the rate of postoperative UCF in pediatric patients undergoing single-stage, primary hypospadias repairs using either AM, TA, or PRP/PRF as a layer interposed between the neourethra and skin. We then performed a pooled proportional meta-analysis of post-operative UCF. Patients within each study who underwent comparable surgery but did not receive a BAUC were used as controls. RESULTS 10 studies were included in our review. The meta-analysis included 280 patients from 7 studies who underwent hypospadias repairs with BAUCs. The pooled incidence of UCF was 10% (95% CI 6-14%). Mean follow-up ranged 5-23.5 months in the 5/7 studies reporting specific durations, and ≥6 month and 14-30 months, respectively, in the other two studies. Patients in whom a BAUC was used had significantly lower odds of UCF than control patients (OR 0.39, 95% CI 0.24-0.64, p = 0.0002). In subgroup analyses, significant superiority held for AM and TA; proximal or penoscrotal cases; transverse preputial island flap (TPIF) technique; when both cases and controls had local flaps; and when neither cases nor controls had flaps. DISCUSSION The use of BAUCs was associated with decreased rates of post-operative UCF in single-stage primary hypospadias repairs and may be most beneficial in more severe cases and when used in addition to local flaps or when using a flap is not possible. In 2/3 studies of PRP/PRF and 2/4 studies of tubularized incised plate (TIP) technique, dartos flaps were used in controls but not BAUC patients, which may explain the lack of benefit demonstrated for these subgroups. This meta-analysis is limited by the quality of evidence in the included studies, which are not uniformly randomized. Furthermore, the follow-up durations and methods for assessing complications are not standardized between included studies. CONCLUSION The meta-analysis herein suggests that using BAUCs may reduce UCF rates following hypospadias surgery. Rigorous prospective evaluation is needed to validate this benefit.
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Affiliation(s)
- George W Moran
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Jane T Kurtzman
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christina P Carpenter
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA; Division of Pediatric Urology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
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Nurtamin T, Renaldo J, Kloping YP, Rahman IA, Hakim L. The use of tissue sealant in reducing urethrocutaneous fistula event following hypospadias repair: A systematic review and meta-analysis. Ann Med Surg (Lond) 2022; 78:103707. [PMID: 35734659 PMCID: PMC9207007 DOI: 10.1016/j.amsu.2022.103707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/20/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background One of the most frequent complications following hypospadias repair is urethrocutaneous fistula (UCF) event. Tissue sealant has been introduced as a means to reduce UCF. However, reports regarding its benefits are varied. Thus, we initiated a systematic review and meta-analysis to investigate its role in reducing UCF following hypospadias repair. Methods We completed a systematic search through the Embase, MEDLINE, and Scopus databases for studies assessing postoperative complications in hypospadias patients undergoing urethroplasty with and without tissue sealant. Cochrane risk of bias 2 (RoB 2) tool was used to assess the quality of randomized clinical trials (RCTs), while the observational studies were assessed with Newcastle-Ottawa Scale. The primary outcome analyzed in this study was UCF, while secondary outcomes consisted of postoperative complications such as edema, infection, and wound dehiscence that increases the risk of UCF formation, measured using odds ratio (OR) with a 95% confidence interval (CI). Results Six eligible studies comprising three RCTs and three non-randomized studies were included. Patients undergoing hypospadias repair with tissue sealant had lower UCF events (OR = 3.27; 95% CI 1.92–5.58; p < 0.0001). Likewise other post-operative complications, tissue sealant group had a lower rate of edema (OR = 2.29; 95% CI 1.38–3.78; p = 0.001) and infection (OR = 3.87; 95% CI 1.55–9.70; p = 0.004). The difference in wound dehiscence was insignificant between the groups (OR = 2.08; 95% CI 0.21–20.55; p = 0.53). Conclusion Tissue sealant can reduce UCF events following hypospadias repair as well as edema and infection that increases the risk of UCF formation.
Tissue sealant can reduce UCF events following hypospadias repair. Edema and infection increase the risk of UCF formation. Tissue sealant provides a watertight surgical anastomosis right after application. Tissue sealant can resist hydrostatic pressure of urine at the surgical suture line.
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Singh A, Anand S, Goel P, Yadav DK, Bajpai M. Can sealing promote healing?: A systematic review and meta-analysis highlighting the adjunctive role of tissue sealant application during urethroplasty for hypospadias. J Pediatr Urol 2021; 17:805-812. [PMID: 34417129 DOI: 10.1016/j.jpurol.2021.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 04/12/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant proportion of children require multiple surgeries for successful repair of hypospadias. This is not only a source of a financial burden to the family but also causes long-term social and psychosexual issues. Tissue sealant application can provide additional coverage to the suture line and subsequently prevents operative failure. However, a consensus statement regarding its usage during urethroplasty is lacking. This systematic review and meta-analysis aims to compare the outcomes of hypospadias surgery, in terms of its complications, in children with and without tissue sealant application. METHOD The authors systematically searched the databases PubMed, EMBASE, Web of Science and Scopus through September 2020. The occurrence of overall complications, and specific complications (including urethrocutaneous fistula, wound-related complications, flap-related complications, complications involving the neo-urethral tube and meatal stenosis) were the primary and secondary outcomes, respectively. Statistical analysis was performed using a random-effects model, and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed utilizing the Downs and Black scale. RESULT Four comparative studies were included in the meta-analysis. The different types of tissue sealants such as fibrin glue, cyanoacrylate glue, BioGlue and cryocalcium glue were used in these studies. As compared to without sealant application, hypospadias repair performed with sealant application showed no significant difference in the incidence of overall postoperative complications (RR 0.63; 95% CI 0.34-1.14, p = 0.13). However, a significant reduction in some specific complications including urethrocutaneous fistula (RR 0.37; 95% CI 0.19-0.72, p = 0.003), wound-related complications (RR 0.57; 95% CI 0.38-0.86, p = 0.008) and complications involving the neo-urethra (RR 0.15; 95% CI 0.04-0.54, p = 0.004) was observed with sealant usage. The average Downs and Black scale scores ranged from 16 to 18, with all studies having a moderate risk of bias. Kappa statistics showed a value of 0.962 (p < 0.001), highlighting an almost perfect agreement among the two observers. CONCLUSION The present meta-analysis revealed no additional benefit of the repair of hypospadias performed with tissue sealants as compared to without sealants in terms of reducing the overall postoperative complications. However, a significant reduction in the occurrence of some specific complications, including UCF, wound-related complications and complications involving the neourethra was observed with sealant application. The level of evidence of the published comparative studies is limited. Therefore, further studies need to be conducted for optimal comparison between the sealant and no sealant (or placebo), and different types of sealants.
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Affiliation(s)
- Apoorv Singh
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | - Sachit Anand
- Department of Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital, Mumbai, 400053, India.
| | - Prabudh Goel
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
| | | | - Minu Bajpai
- Department of Pediatric Surgery, AIIMS, New Delhi, 110029, India
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Ambriz-González G, Aguirre-Ramirez P, García-de León JM, León-Frutos FJ, Montero-Cruz SA, Trujillo-Trujillo XAR, Fuentes-Orozco C, Macías-Amezcua MD, del Socorro Álvarez-Villaseñor A, Cortés-Flores AO, Chávez-Tostado M, González-Ojeda A. 2-octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: a randomized controlled trial. BMC Urol 2014; 14:93. [PMID: 25416602 PMCID: PMC4246544 DOI: 10.1186/1471-2490-14-93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/16/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Urethrocutaneous fistulae (UCFs) represent one of the most frequent causes of morbidity after urethroplasty. Hypospadias can be repaired using different surgical techniques, but-regardless of technique-the incidence of UCF ranges between 10% and 40%. Surgical repair of UCF remains the treatment of choice, even if some patients need further surgery because of recurrences. Cyanoacrylates have been used as skin suture substitutes, and some evidence suggests a beneficial effect when these adhesives are used as an adjuvant in the management of UCF. Here we describe the results of management of UCF using 2-octyl cyanoacrylate (OCA) compared with surgical repair. METHODS A randomized clinical trial conducted from January 2008 to December 2012 included 42 children with UCF complications after urethroplasty for hypospadias. Twenty-one children were assigned to receive OCA as ambulatory patients and 21 were treated surgically. The main outcome variable was closure of the UCF. The estimated costs of both treatments were also calculated, as were absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) to prevent a surgical intervention. RESULTS The mean numbers of UCF were 1.3 in the OCA group (n = 28) and 1.1 in the surgical group (n = 25) with no statistically significant difference. The external orifices measured were 2.96 ± 1.0 mm and 3.8 ± 0.89 mm, respectively (NS). Sixty per cent of the UCFs treated with cyanoacrylate were completely closed and 68% of the surgical group healed completely (NS). More than one reoperation to improve complications was needed in the surgical group (3.5 ± 1.2). The clinical significance of the therapeutic usefulness of OCA was demonstrated by an ARR of 0.08, RRR of 0.25 and NNT of 12 to avoid further surgical treatment. The total costs of adhesive applications and reoperations were $US 14,809.00 and $US 158,538.50, respectively. CONCLUSIONS The results showed a similar success rate for both treatments. However, sealant use should be considered before surgical treatment because this is a simple outpatient procedure with a reasonable success rate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02115191. Date: April 13, 2014.
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Affiliation(s)
- Gabriela Ambriz-González
- />Pediatrics Surgery Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | - Pedro Aguirre-Ramirez
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | - José Manuel García-de León
- />Pediatrics Surgery Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | | | | | | | - Clotilde Fuentes-Orozco
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Michel Dassaejv Macías-Amezcua
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | | | - Ana Olivia Cortés-Flores
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Mariana Chávez-Tostado
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Alejandro González-Ojeda
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
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Guinot A, Arnaud A, Azzis O, Habonimana E, Jasienski S, Frémond B. Preliminary experience with the use of an autologous platelet-rich fibrin membrane for urethroplasty coverage in distal hypospadias surgery. J Pediatr Urol 2014; 10:300-5. [PMID: 24325905 DOI: 10.1016/j.jpurol.2013.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 05/20/2013] [Accepted: 09/26/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Platelet-rich fibrin (PRF) has been shown to have structural and biological properties that promote tissue healing. This prospective study evaluated the feasibility, safety, and efficiency of using autologous PRF membrane for urethroplasty coverage in distal hypospadias. MATERIALS AND METHODS We prospectively included 33 patients with distal hypospadias operated on between June 2010 and September 2011. Urethroplasties were performed using the Duplay technique. During surgery, 5-10 ml of patient's blood was collected and immediately centrifuged. A PRF clot was transformed into a dense fibrin membrane with a particular cell content and architecture. This membrane was applied and sutured over the urethroplasty. The perioperative course and complications were recorded. Outcomes were compared with those in a control group of children undergoing the same procedure, but with another mean of coverage. RESULTS With a median follow-up of 8 months (range, 6-18 months), urethral fistula occurred in 2/33 patients. No other complication was noted. No complication related to the blood sampling was reported. There was no statistically significant difference with the control group (p = 0.65). CONCLUSION The PRF patch seems to be a safe and efficient covering technique. Thus, procedure is an additional approach to coverage for hypospadias surgery, and may help to reduce the incidence of postoperative complications when coverage healthy tissue is not available.
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Affiliation(s)
- A Guinot
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France.
| | - A Arnaud
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France
| | - O Azzis
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France
| | - E Habonimana
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France
| | - S Jasienski
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France
| | - B Frémond
- Department of Pediatric Surgery, University Hospital of Rennes, F-35000, France
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Kajbafzadeh AM, Sabetkish S, Tourchi A, Amirizadeh N, Afshar K, Abolghasemi H, Elmi A, Talab SS, Eshghi P, Mohseni MJ. The application of tissue-engineered preputial matrix and fibrin sealant for urethral reconstruction in rabbit model. Int Urol Nephrol 2014; 46:1573-80. [DOI: 10.1007/s11255-014-0684-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/12/2014] [Accepted: 02/25/2014] [Indexed: 11/25/2022]
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Soyer T, Ayva Ş, Boybeyi Ö, Aslan MK, Çakmak M. The effect of platelet rich fibrin on growth factor levels in urethral repair. J Pediatr Surg 2013; 48:2545-9. [PMID: 24314201 DOI: 10.1016/j.jpedsurg.2013.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/10/2013] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 11/19/2022]
Abstract
AIM Platelet rich fibrin (PRF) is an autologous source of growth factors and promotes wound healing. An experimental study was performed to evaluate the effect of PRF on growth factor levels in urethral repair. MATERIALS AND METHODS Eighteen Wistar albino rats were included in the study. Rats were allocated in three groups (n:6): control (CG), sham (SG), and PRF (PRFG). In SG, a 5 mm vertical incision was performed in the penile urethra and repaired with 10/0 Vicryl® under a microscope. In PRFG, during the urethral repair as described in SG, 1 cc of blood was sampled from each rat and centrifuged for 10 minutes at 2400 rpm. PRF obtained from the centrifugation was placed on the repair site during closure. Penile urethras were sampled 24 hours after PRF application in PRFG and after urethral repair in SG. Transforming growth factor beta receptor (TGF-β-R-CD105), vascular endothelial growth factor (VEGF) and its receptor (VEGF-R), as well as endothelial growth factor receptor (EGFR), were evaluated in subepithelia of the penile skin and urethra. Groups were compared for growth factor levels and growth factor receptor expression with the Kruskal Wallis test. RESULTS TGF-β-R levels were significantly decreased in SG when compared to CG (p<0.05). In PRFG, TGF-β-R was increased in both subepithelia of penile skin and urethra with respect to SG (p<0.05). When VEGF levels and its receptor expression were compared between SG and PRFG, VEGF levels were found to be increased in penile skin subepithelium, whereas VEGF-R expressions were decreased in urethral subepithelia in PRFG (p<0.05). There was no difference between groups for EGFR levels (p>0.05). CONCLUSION Use of PRF after urethral repair increases TGF-β-R and VEGF expressions in urethral tissue. PRF can be considered as an alternative measure to improve the success of urethral repair.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, School of Medicine, Ankara, Turkey.
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Kocherov S, Lev G, Chertin B. Use of BioGlue Surgical Adhesive in Hypospadias Repair. Curr Urol 2013; 7:132-5. [PMID: 24917774 DOI: 10.1159/000356265] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/16/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To prospectively evaluate the efficacy of albumin glutaraldehyde tissue adhesive (BioGlue) in the surgical treatment of patients with hypospadias. MATERIALS AND METHODS Two groups of 20 patients each who underwent hypospadias repair were included in the study. In the first group we utilized BioGlue as an additional protective layer to the suture line of the neo-urethra, while patients in the second group were operated on utilizing a routine surgical technique. RESULTS There were no statistical differences between patients from the 2 groups in terms of surgical complications. Urethrocutaneous fistula was revealed in 4 (20%) patients after repair with BioGlue and in 3 (15%) patients from the control group (p = 0.686), suture line breakdown in 4 (20%) and in 1 (5%) patients (p = 0.478), meatal stenosis in 1 (5%) and in 1 (5%) patient (p = 1). Furthermore more patients in the BioGlue group (n = 12, 60%) demonstrated poor cosmetic results compared to the control group where most patients - 19 (95%) had acceptable cosmetic outcomes (p = 0.007). CONCLUSIONS Our data showed no benefits of BioGlue use in hypospadias repair.
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Affiliation(s)
- Stanislav Kocherov
- Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Genady Lev
- Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
| | - Boris Chertin
- Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medical Science, Hebrew University, Jerusalem, Israel
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Soyer T, Çakmak M, Aslan MK, Şenyücel MF, Kisa Ü. Use of autologous platelet rich fibrin in urethracutaneous fistula repair: preliminary report. Int Wound J 2012; 10:345-7. [PMID: 22568526 DOI: 10.1111/j.1742-481x.2012.00983.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/30/2022] Open
Abstract
Urethrocutaneous fistula (UCF) is one of the most common complications occurring after hypospadias repair. Despite the surgical advancement in hypospadias, multiple failed fistula closures are commonly referred to paediatric urologists. Although several techniques have been described to interpose a waterproof layer between urethral and skin closures, occurrence of urethrocutaneous fistula cannot be eliminated completely. In addition to several local tissue grafts, autologous and homologous fibrin sealants are used to prevent UCF. Platelet rich fibrin (PRF) is known as an autologous source of growth factors obtained from the sera of the patient. PRF supports collagen synthesis and tissue repair and accelerates wound healing. We aimed to present our initial experience about the use of autologous PRF in a 3-year-old boy with a UCF after hypospadias repair.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, School of Medicine, Kırıkkale University, 71100 Kırıkkale, Turkey.
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Kajbafzadeh AM, Abolghasemi H, Eshghi P, Alizadeh F, Elmi A, Shafaattalab S, Dianat S, Amirizadeh N, Mohseni MJ. Single-donor fibrin sealant for repair of urethrocutaneous fistulae following multiple hypospadias and epispadias repairs. J Pediatr Urol 2011; 7:422-7. [PMID: 20634140 DOI: 10.1016/j.jpurol.2010.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/07/2010] [Accepted: 06/10/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy of fibrin sealant for repair of urethrocutaneous fistula after multiple failed hypospadias and epispadias surgeries. MATERIALS AND METHODS The study population comprised 11 boys (mean age 12.18 years) with history of hypospadias or epispadias and at least two failed fistula repair operations leading to recurrent urethrocutaneous fistula. During the operation, single-donor fibrin glue, either from the patient (7) or a parent (4), was applied over the suture lines and beneath the skin. A urethral catheter was kept in place for 7-10 days. Follow up ranged from 6 to 24 months (mean 12.63 months). RESULTS Nine patients had an uneventful postoperative course. In one patient with a large fistula, partial wound dehiscence occurred. In another patient with complete hypospadias, hematoma formation caused skin dehiscence but the urethra remained intact. Both cases recovered after 6 months with no further intervention. No fistula recurrence was reported during follow up. CONCLUSION Single-donor fibrin glue could be a useful adjunct to surgical management of patients after multiple failed attempts at hypospadias or epispadias fistula repair. Moreover, this product improves the safety margin regarding the risk of disease transmission.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Objective: Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research. Materials and Methods: A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemostatics, cyanoacrylate adhesives, oxidized regenerated cellulose, and microfibrillar collagen were included. References were chosen from a broad range of surgical literature. Results: Topical hemostatic agents have historically taken advantage of a wide variety of mechanisms for hemostasis. Fibrin sealants have a rich history and large potential for further applications. Gelatin sponge hemostatics have been widely used since their introduction, but have changed little. Cyanoacrylate adhesives have a unique mechanism and opportunity for novel applications of existing products. Oxidized cellulose was original in the use of plant-based components. Microfibrillar collagen hemostats have evolved to a wide variety of formats. Conclusions: A review of the evolution of topical hemostatic agents highlights opportunities for potential novel research. Fibrin sealants may have the most opportunity for advancement, and understanding the history of these products is useful. With the drive in urology for minimally invasive surgical techniques, adaptation of topical hemostatic agents to this surgical approach would be valuable and offers an opportunity for novel contributions.
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Affiliation(s)
- Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis
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Abstract
Purpose Complications in hypospadias surgery are higher than other reconstructive procedures. The incidence of complications can be reduced if proper preventive measures are taken. The review aims to highlight incidences, causes, and preventive measures of acute complications of hypospadias repair. Materials and Methods Literature reports were reviewed in Pubmed by giving the key word acute complications of hypospadias repair, wound infection, wound dehiscence, flap necrosis, edema, penile torsion, urethral fistula, bleeding and hematoma and urethral stents problems. Summaries of all articles were reviewed with full text of relevant article and results were analyzed. Results Besides mentioning the complications of hypospadias repair in individual articles on the subject, we did not come across any separate article on this subject in the published English literature. Fistula is the commonest complication followed by edema and penile torsion. Conclusions Most acute complications can be prevented with adherence to principles of plastic and microsurgery, meticulous preoperative planning, and judicious postoperative care. Deviation from these principles may lead to disaster and even failure of the repair. The aim in hypospadias surgery should be following these principles and bring down the complication rates < 5% in distal hypospadias and < 10% in proximal hypospadias.
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Sundaram CP, Keenan AC. Evolution of hemostatic agents in surgical practice. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2010. [PMID: 21116358 DOI: 10.4103/0970-1591.70574.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Academic Contribution Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Topical hemostatic agents are used in a wide variety of surgical settings, and the evolution of this class of surgical tools is an interesting topic. We reviewed and outlined the historical progress of topical hemostats into present day surgery and urology, and highlight opportunities for future research. MATERIALS AND METHODS A MEDLINE search of all available literature concerning several classes of topical hemostatic agents was performed. Fibrins sealants, Gelatin sponge hemostatics, cyanoacrylate adhesives, oxidized regenerated cellulose, and microfibrillar collagen were included. References were chosen from a broad range of surgical literature. RESULTS Topical hemostatic agents have historically taken advantage of a wide variety of mechanisms for hemostasis. Fibrin sealants have a rich history and large potential for further applications. Gelatin sponge hemostatics have been widely used since their introduction, but have changed little. Cyanoacrylate adhesives have a unique mechanism and opportunity for novel applications of existing products. Oxidized cellulose was original in the use of plant-based components. Microfibrillar collagen hemostats have evolved to a wide variety of formats. CONCLUSIONS A review of the evolution of topical hemostatic agents highlights opportunities for potential novel research. Fibrin sealants may have the most opportunity for advancement, and understanding the history of these products is useful. With the drive in urology for minimally invasive surgical techniques, adaptation of topical hemostatic agents to this surgical approach would be valuable and offers an opportunity for novel contributions.
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Affiliation(s)
- Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis
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Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair. J Pediatr Surg 2008; 43:1869-72. [PMID: 18926223 DOI: 10.1016/j.jpedsurg.2008.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 11/25/2007] [Revised: 04/13/2008] [Accepted: 04/14/2008] [Indexed: 02/08/2023]
Abstract
UNLABELLED Urethrocutaneous fistula is one of the most common complications after hypospadias surgery. The incidence of fistula development has varied from 4% to 20% in larger series. We sought to investigate the role of fibrin glue (Tisseel manufactured by Baxter India Pvt Ltd, Chennai, India) to reduce the chances of fistula formation in cases in proximal penile hypospadias. METHOD A total of 120 patients with proximal penile hypospadias (patients having urethral meatus at posterior third of penile shaft and at penoscrotal junction) were included in the present study. Patients were randomly allocated into 2 groups of 60 each by using Strata 9 software random number table. In group A, fibrin glue was used as a sealant after hypospadias surgery, whereas in group B, no sealant was used. All the operations were performed by single surgeon using transverse preputial tubularized island flap urethroplasty. RESULT Fistula formation occurred in 6 cases in group A (10%) and 19 cases in group B (32%) (P = .027). The fistulae observed in fibrin glue group A were single and small in size (<1 mm). Multiple (>or=2 fistulae) and larger fistulae (>2 mm) were observed in group B. Overall complication was significantly higher in group B (P = .006). CONCLUSION Fibrin glue in hypospadias repair does not eliminate fistula formation. However, it seems that it minimizes the incidence of fistula formation.
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Abstract
PURPOSE OF REVIEW This article details the diverse urologic applications of tissue glues and hemostatic agents over the past 3 years in the management of genitourinary injuries, surgical wounds, and complications. RECENT FINDINGS Biosurgical agents designed to promote tissue adhesion and hemostasis are being increasingly employed across all surgical disciplines. Fibrin sealant is the most widely utilized biosurgical product. Gelatin matrix thrombin has proven to be an efficacious hemostatic agent. Bovine serum albumin-gluataraldehyde is a new, promising tissue glue. Complex reconstructive, oncologic and laparoscopic procedures are those most appropriate for sealant use in urology. SUMMARY Tissue glues and hemostatic agents are effective, safe, and their use is increasing. All urologists should have a working knowledge of these adjuncts.
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