Despit the different surgical options for hypospadias repair no technique is considered the golden standard. Hypospadias repair still remains a challanging condition for even the most talented surgeons. However, the results of repair have evolved over time; there is still need fore more easier and less invasive technique
We conducted this study aiming to prove that the use of fibrin sealant is an easier, less invasive and effective in hyopspadias repaire. We enrolled 40 patients in our study. Their age ranged from 2 to 21 years. Of the 40 candidates, 2 cases (5%) were subcoronal, 12 cases (30%) were distal penile, 26 cases (65%) midpenile hypospadias.
The cases were evenly distributed into 2 groups (20 each). The first group was managed by tip technique using fibrin glue without dartos flap; the second group was managed by the ordinary TIP procedur using vascularised dartos flap. The distribution into these groups was random.
One of the most important exclusion criteria in this study was the sacrifice of the native urethral plate, any such case was omitted. Therefore, the preservation of the urethral plate was a necessity for inclusion.
Our follow up period extended throughout a 6 month period postoperatively.
Group I results showed a 10% incidence of fistulation , 5% incidence of skin discoloration , 5% incidence of meatal stenoses, 70% incidence of mild infection that wase controlled by medical treatment and 15% incidence of penile odema. The cosmetic outcome was satisfactory.
Group II results showed a 35% incidence of fistulation , 25% incidence of skin discoloration ,10% incidence of meatal stenoses, 25% incidence of infection that wase controlled by medical treatment and 40% incidence of penile edema. The cosmetic outcome was satisfactory.
The results were tabulated and statistically analyzed. There was statistical significance in the rate of complications between 2 groups. We notice that there is lower incidence of fistula in group I than the other group .also lower incidence of post operative penile edema and skin discoloration with group I. there was more incidence of infection with group I.
In this study, we noticed that the development of dartos flab in group II needs more dissection more tissue trauma adding more difficulty to the procedure also more time is needed other than the group I. This meant that fibrin sealant application is an easier procedure, with less liability to skin ischemia and discoloration. It was also noticeable that the disadvantage of increasing incidence of infection is easily controlled conservatively and did not lead to more complication.
We also compared our results with the literature and previous studies. Our study showed similar results to most of the published data.
In future, we recommend that this study be extended to involve a bigger sample to provide us with ample results to signify such a comparison. We also recommend it to be performed at a multicentre level to confirm our data. We recommend using biological glue as a sealant and healing promoter for hypospadias repair and we hop that more studies will appear in the future to confirm its efficacy in different urological fields.
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