The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

Abstract

This investigative pilot study was conducted with the objective of evaluating the therapeutic effect of a cream containing hyaluronic acid (HA) and silver-sulfadiazine (Altergen®, IBSA Farmaceutici Italia, S.r.l.) in adult patients undergoing two-stage urethroplasty using an oral mucosal graft for anterior urethral strictures due to failed hypospadias repair. We used a cream (Altergen®) containing the following active ingredients: 100 g HA, 0.20 mg sodium salt, and 1 g silver-sulfadiazine. During the period of January 2009 - May 2010, 40 patients, mean age 24 years, who had undergone hypospadias surgery during childhood were enrolled in the study, according to some inclusion and exclusion criteria (age >18 years, with the absence of diabetes, neurovascular disease, lichen sclerosus or other dermatological lesions). All 40 patients had navicularis or penile urethral strictures and underwent two-stage urethroplasty using an oral mucosa graft. Post-operatively, 20 patients (50%) were treated with a cream containing HA and silver-sulfadiazine (Altergen®) and 20 patients (50%) were treated using a standard topical treatment (iodopovidone 10% gel). All patients underwent a follow-up at 6, 15, 30, 60 and 120 days after surgery. Out of the 20 patients treated with the HA and silver-sulfadiazine-containing cream (Altergen®), 18 (90%) showed good and complete healing of the graft implant 30 days after surgery. Of the 20 patients not treated with the HA and silver-sulfadiazine-contaning cream (Altergen®), 13 (65%) showed good and complete healing of the graft implant 30 days after surgery. These results were constant in all follow-ups in both patient groups. In patients who underwent a navicularis or penile two-stage oral mucosal graft urethroplasty, the use of a HA and silver-sulfadiazine-containing cream was associated with a higher success rate of the graft implant and a lower incidence of post-surgical complications compared to the controls.