Preliminary Use of Indocyanine Green Fluorescence Angiography in Predicting the Blood Perfusion of Neourethra Covering in TIP Hypospadias Repair.

OBJECTIVE

To evaluate the utility of indocyanine green fluorescence angiography (ICG-FA) for the semiquantitative assessment of perfusion in neourethral covering tissues.

METHODS

Fourteen boys undergoing primary hypospadias repair between April and May 2021 were enrolled. Standardized ICG-FA was performed using the SPY Elite system. Tissue perfusion was categorized based on grayscale fluorescence intensity into 2 groups as follows: well perfused (fluorescence intensity matching adjacent tissues) and poorly perfused (markedly reduced fluorescence). Surgical outcomes were compared over a mean follow-up period of 24 months (range, 18-40 months).

RESULTS

All patients underwent tubularized incised plate (TIP) urethroplasty. ICG-FA provided clear visualization in all cases, with no adverse events observed. Among the ten patients in the well-perfused group, no evidence of tissue necrosis or urethrocutaneous fistulas occurred; one case of glans dehiscence was noted. In contrast, all 4 patients in the poorly perfused group developed ventral necrotic crusts, and 3 (75%) developed fistulas.

CONCLUSION

ICG-FA is a safe and effective technique for intraoperative identification of perfusion deficits in hypospadias repair. Perfusion status, as determined by ICG-FA, was strongly associated with postoperative complications, providing an objective basis to guide intraoperative decision-making.