Neheman A, Rappaport YH, Verhovsky G, Bush N, Snodgrass W, Lang E, Zisman A, Efrati S, et al.
Journal of pediatric urology. Date of publication 2020 Apr 1;volume 16(2):163.e1-163.e7.
1. J Pediatr Urol. 2020 Apr;16(2):163.e1-163.e7. doi:
10.1016/j.jpurol.2020.01.002. Epub 2020 Jan 14.
Hyperbaric oxygen therapy for pediatric "hypospadias cripple"-evaluating the
advantages regarding graft take.
Neheman A(1), Rappaport YH(2), Verhovsky G(3), Bush N(4), Snodgrass W(4), Lang
E(5), Zisman A(1), Efrati S(5).
Author information:
(1)Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin,
Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
(2)Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin,
Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Electronic address: yhrapp@gmail.com.
(3)Departments of Urology, Shamir (Assaf-Harofeh) Medical Center, Zerifin,
Israel.
(4)Parc Urology, Frisco, TX, USA.
(5)Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf-Harofeh)
Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel.
Comment in
J Pediatr Urol. 2020 Aug;16(4):519-520.
J Pediatr Urol. 2020 Aug;16(4):517-518.
INTRODUCTION: Hypospadias cripple patients pose a major surgical challenge with
high complication rates attributed mainly to graft contraction. Hyperbaric
oxygen therapy (HBOT) is an established treatment for compromised grafts and
used extensively as a salvage therapy for compromised grafts and ischemic
non-healing wounds.
OBJECTIVE: We evaluated the graft-take rates in hypospadias cripple cases
undergoing a staged tubularized autograft repair (STAG) and compared between
patients treated with or without preemptive HBOT.
MATERIALS AND METHODS: All patients underwent a STAG. Patients receiving
preemptive HBOT were compared with patients receiving the standard surgical
procedure without HBOT. The HBOT protocol included a daily session, 5 days per
week for four weeks before the surgery and 10 additional daily sessions
immediately after first-stage surgery. Each HBOT session included 90 min
exposure to 100% O2 at 2 atmospheres absolute with 5 min air breaks every
20 min. The primary endpoint was graft take. Sequential tubularization without
tension at second stage was defined as success.
RESULTS: Seven boys received HBOT and 14 boys comprised the control group. All
patients in the HBOT group had good graft take with no graft contraction. In the
control group, 57% had good graft take and could proceed to the second-stage
surgery and 43% had graft contraction (Table). Except for one patient who had
claustrophobia while entering the chamber, no significant side-effects developed
during the HBOT.
DISCUSSION: The basic pathophysiology of compromised flaps includes both
ischemia and reperfusion injury, which can be attenuated by HBOT. The beneficial
effects of HBOT relates to several mechanisms, including hyperoxygenation,
fibroblast proliferation, collagen deposition, angiogenesis, and vasculogenesis.
Graft contraction is a well-known complication in hypospadias cripple population
with reported failure rate of 39-63%. The HBOT procedure was found to be very
effective and the entire HBOT group had a good graft take. Accordingly, all
patients in the HBOT group proceeded to a successful second-stage
tubularization. In addition, HBOT was found to be safe and generally well
tolerated by this pediatric population. Study limitations were a relative small,
non-homogenous sample size and lack of prospective randomization. Success was
defined as sufficient graft elasticity sufficing for tubularization of the
neourethra, and exact graft measurements are lacking in this study.
CONCLUSIONS: Preemptive HBOT can be used safely in the hypospadias cripple
pediatric population and can potentially reduce the expected high surgical
failure secondary to graft contraction.
Copyright © 2020. Published by Elsevier Ltd.
DOI: 10.1016/j.jpurol.2020.01.002
PMID: 32171667 [Indexed for MEDLINE]
