Prospective comparative study of hypospadias surgical repair with and without the use of fibrin sealant
Keywords:Hypospadias, Fibrin sealant, TIP, Urethra cutaneous fistula, Fibrogloo
Background: Hypospadias is the most common congenital malformation of the penis, affecting about 4-6 males per 1000 male births, and ranging in severity from a urethral meatus that is slightly off-center to a meatus in the perineal area, The aim of this study was to evaluate whether the application of fibrin sealant over the suture lines of neo-urethra reduces complications and improve overall outcome in children hypospadias repair.1,2
Methods: It was a prospective comparative study conducted in a tertiary care center (Department of pediatric surgery - Menoufia University), we included the patients age more than 6 months and less than 4 years presented with hypospadias to our department in this study. A total 30 patients of coronal, sub coronal, mid shaft hypospadias and distal hypospadias were studied and were divided into two groups, group (A) 15 cases and group (B) 15 cases. All patients underwent a tabularized incised plate (TIP) repair with a Dartos vascularized pedicle flap to cover the neo-urethra, In group (B) a thin layer of fibrin sealant applied over the suture line of neo-urethra but no sealant was used in group (A).
Results: Postoperative surgical complications: urethra cutaneous fistula, flap dehiscence, flap necrosis and urethral stricture were recorded. Urethrocutaneous fistula flap dehiscence and flap necrosis were lower in group (B) patients. There was no significant difference in postoperative urethral stricture between two groups.
Conclusions: Use of fibrin sealant in hypospadias repair is safe and can reduce complications.
Shih EM, Graham JM. Review of genetic and environmental factors leading to hypospadias. Eur J Med Genet. 2014;57:453e63.
Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The genetic and environmental factors underlying hypospadias. Sex Dev. 2015;9:239–59.
Camoglio FS, Bruno C, Zambaldo S, Zampieri N. Hypospadias anatomy: Elastosonographic evaluation of the normal and hypospadic penis. J Pediatr Urol. 2016;12(4):199.
Bhat A, Mandal AK. Acute postoperative complications of hypospadias repair. Indian J Urol. 2008;24:2418.
Craig JR, Wallis C, Brant WO, Hotaling JM, Myers JB. Management of adults with prior failed hypospadias surgery. Transl Androl Urol. 2014;3:196-204.
Singh H, Majhi TK. Prospective comparative study of adult hypospadias surgical repair with and without the use of fibrin sealant. Sch. Acad J Biosci. 2017;5(9):670-3.
Kinahan TJ, Johnson HW. Tisseel in hypospadias repair. Can J Surg. 1992;35:757.
Kocherov S, Lev G, Chertin B. Use of BioGlue Surgical Adhesive in Hypospadias Repair. Curr Urol. 2013;7:132-5.
Joch C. The safety of fibrin sealants. Cardiovasc Surg. 2003;11(Suppl 1):23-8.