Additive outcome of platelet rich fibrin neourethral coverage of tubularized incised plate in primary distal hypospadias repair

Abstract

BackgroundHealing complications are a significant concern after hypospadias repair, often attributed to deficient growth factors and reduced healing potential of hypospadiac tissue. Platelet-Rich Fibrin (PRF), a new generation of platelet concentrates rich in growth factors, has been successfully applied to provide a mechanical barrier and promote healing in different surgical fields. The objective of this study was to assess the role of a PRF membrane covering the neourethra, in addition to a Dartos flap, optimizing the outcomes of primary distal hypospadias repair.MethodsForty-four patients undergoing primary distal hypospadias repair were randomized and then assigned to two groups according to the covering layer(s) applied over the neourethra in Tubularized Incised Plate (TIP) repair. Each group included 22 cases with an average age of 38 ± 28 months for group A and 30 ± 21 months for group B. In group A, the classical technique of a single Dartos flap was used. In group B, an autologous PRF membrane -prepared during surgery using the patient’s own serum- was placed to the neourethra and subsequently covered with Dartos flap.Resultswith a mean follow up of 17.9 ± 7.2 months (range 6–30 months), group B had the lowest rate of complicated cases (9.1% compared to 31% for group A), Nevertheless, this finding was not statistically significant. The implementation of PRF in group B scaled down the rate of urethrocutaneous fistula (UCF) formation to 4.5% compared to 18.2% in group A. Furthermore, group B had no incidence of wound infection compared to 22.7% in group A (p < 0.05).ConclusionCombined neourethral coverage with a PRF membrane and a Dartos flap leads to a trend toward a significant decrease in rate of UCF and leads to a significant reduction in wound infection after TIP repair compared to a single Dartos flap after TIP repair compared to a single Dartos flap. The technique is technically simple, inexpensive and is also not time-consuming.