Journal of pediatric urology · 2025
Optimizing outcomes in redo hypospadias repair: The impact of perioperative hyperbaric oxygen therapy on tissue healing.
СтатьяНазвание и аннотация: Перевод в очереди
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Álvarez Vega Diego R, Mendelson Jordan L, Gitlin Jordan S, Katz Alan, Gamal Ashraf F, Hodgen Katharine, Hanna Moneer K
Аннотация
INTRODUCTION: Redo hypospadias repairs present significant challenges due to tissue scarring and hypovascularity, substantially increasing the risk of complications. Previous literature document complication rates above 40 % after three or more previous urethroplasties, highlighting the need for strategies that enhance tissue quality. Postoperative hyperbaric oxygen therapy (HBOT) can improve healing outcomes. However, the role of perioperative HBOT in enhancing tissue quality through neovascularization remains unclear. This study aims to evaluate whether perioperative HBOT (both pre- and postoperative) instead of the senior author's standard of care (SOC) topical nitroglycerin reduces complication rates and improves surgical outcomes in redo hypospadias repair.
METHODS: We retrospectively reviewed 47 patients (aged 3-18 years) who underwent redo hypospadias repairs between January 2019 and January 2022, following 2-4 prior failed procedures. Inclusion criteria included patients with failed primary repairs, while exclusion criteria included patients with contraindications to HBOT or incomplete follow-up data. Patients were allocated to treatment groups (i.e. perioperative HBOT v. SOC) based on insurance coverage for HBOT rather than randomization. Group 1 (n = 31) received perioperative HBOT while Group 2 (n = 16) received SOC, consisting of topical nitroglycerin ointment. Additionally, BMG patients in both groups received topical vitamin E for 2-3 weeks post-operatively. HBOT protocol consisted of 20 preoperative sessions and 5-10 postoperative sessions at 2.0 ATA.
RESULTS: The two groups did not differ significantly in hypospadias locations (Group 1: 22 distal, 9 proximal; Group 2: 10 distal, 6 proximal; P = 0.795) or operative technique (Group 1: 21 one-stage dorsal inlay grafts [DIG], 10 staged buccal mucosa grafts [BMG]; Group 2: 10 one-stage DIG, 6 staged BMG; P = 0.972). The HBOT group demonstrated a reduction in postoperative complications compared to SOC group (6.4 % vs. 25 %; P = 0.179 95 % CI 0.05-1.26), though this difference did not reach the level of statistical significance. Specifically, the HBOT group experienced only two cases of fistula formation, while the SOC group had four total complications: one case of graft contracture and three fistulas. All complications were successfully corrected surgically one year postoperatively using the perioperative HBOT protocol. Subjective clinical assessment also suggested improved tissue quality and pliability in HBOT-treated patients.
CONCLUSIONS: This study suggests that perioperative HBOT was associated with a lower, but not statistically significant, complication rate in redo hypospadias repairs. The findings support the potential use of perioperative HBOT in promoting tissue healing and justify further investigation through prospective randomized controlled trials to establish definitive efficacy and optimize treatment protocols for this challenging patient population.
METHODS: We retrospectively reviewed 47 patients (aged 3-18 years) who underwent redo hypospadias repairs between January 2019 and January 2022, following 2-4 prior failed procedures. Inclusion criteria included patients with failed primary repairs, while exclusion criteria included patients with contraindications to HBOT or incomplete follow-up data. Patients were allocated to treatment groups (i.e. perioperative HBOT v. SOC) based on insurance coverage for HBOT rather than randomization. Group 1 (n = 31) received perioperative HBOT while Group 2 (n = 16) received SOC, consisting of topical nitroglycerin ointment. Additionally, BMG patients in both groups received topical vitamin E for 2-3 weeks post-operatively. HBOT protocol consisted of 20 preoperative sessions and 5-10 postoperative sessions at 2.0 ATA.
RESULTS: The two groups did not differ significantly in hypospadias locations (Group 1: 22 distal, 9 proximal; Group 2: 10 distal, 6 proximal; P = 0.795) or operative technique (Group 1: 21 one-stage dorsal inlay grafts [DIG], 10 staged buccal mucosa grafts [BMG]; Group 2: 10 one-stage DIG, 6 staged BMG; P = 0.972). The HBOT group demonstrated a reduction in postoperative complications compared to SOC group (6.4 % vs. 25 %; P = 0.179 95 % CI 0.05-1.26), though this difference did not reach the level of statistical significance. Specifically, the HBOT group experienced only two cases of fistula formation, while the SOC group had four total complications: one case of graft contracture and three fistulas. All complications were successfully corrected surgically one year postoperatively using the perioperative HBOT protocol. Subjective clinical assessment also suggested improved tissue quality and pliability in HBOT-treated patients.
CONCLUSIONS: This study suggests that perioperative HBOT was associated with a lower, but not statistically significant, complication rate in redo hypospadias repairs. The findings support the potential use of perioperative HBOT in promoting tissue healing and justify further investigation through prospective randomized controlled trials to establish definitive efficacy and optimize treatment protocols for this challenging patient population.