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Ambriz-González G, Aguirre-Ramirez P, García-de León JM, León-Frutos FJ, Montero-Cruz SA, Trujillo-Trujillo XAR, Fuentes-Orozco C, Macías-Amezcua MD, del Socorro Álvarez-Villaseñor A, Cortés-Flores AO, Chávez-Tostado M, González-Ojeda A. 2-octyl cyanoacrylate versus reintervention for closure of urethrocutaneous fistulae after urethroplasty for hypospadias: a randomized controlled trial. BMC Urol 2014; 14:93. [PMID: 25416602 PMCID: PMC4246544 DOI: 10.1186/1471-2490-14-93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Urethrocutaneous fistulae (UCFs) represent one of the most frequent causes of morbidity after urethroplasty. Hypospadias can be repaired using different surgical techniques, but-regardless of technique-the incidence of UCF ranges between 10% and 40%. Surgical repair of UCF remains the treatment of choice, even if some patients need further surgery because of recurrences. Cyanoacrylates have been used as skin suture substitutes, and some evidence suggests a beneficial effect when these adhesives are used as an adjuvant in the management of UCF. Here we describe the results of management of UCF using 2-octyl cyanoacrylate (OCA) compared with surgical repair. METHODS A randomized clinical trial conducted from January 2008 to December 2012 included 42 children with UCF complications after urethroplasty for hypospadias. Twenty-one children were assigned to receive OCA as ambulatory patients and 21 were treated surgically. The main outcome variable was closure of the UCF. The estimated costs of both treatments were also calculated, as were absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT) to prevent a surgical intervention. RESULTS The mean numbers of UCF were 1.3 in the OCA group (n = 28) and 1.1 in the surgical group (n = 25) with no statistically significant difference. The external orifices measured were 2.96 ± 1.0 mm and 3.8 ± 0.89 mm, respectively (NS). Sixty per cent of the UCFs treated with cyanoacrylate were completely closed and 68% of the surgical group healed completely (NS). More than one reoperation to improve complications was needed in the surgical group (3.5 ± 1.2). The clinical significance of the therapeutic usefulness of OCA was demonstrated by an ARR of 0.08, RRR of 0.25 and NNT of 12 to avoid further surgical treatment. The total costs of adhesive applications and reoperations were $US 14,809.00 and $US 158,538.50, respectively. CONCLUSIONS The results showed a similar success rate for both treatments. However, sealant use should be considered before surgical treatment because this is a simple outpatient procedure with a reasonable success rate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02115191. Date: April 13, 2014.
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Affiliation(s)
- Gabriela Ambriz-González
- />Pediatrics Surgery Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | - Pedro Aguirre-Ramirez
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | - José Manuel García-de León
- />Pediatrics Surgery Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
- />Pediatrics Urology Department, Medical Unit of High Specialty, Pediatrics Hospital of the Western Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco México
| | | | | | | | - Clotilde Fuentes-Orozco
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Michel Dassaejv Macías-Amezcua
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | | | - Ana Olivia Cortés-Flores
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Mariana Chávez-Tostado
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
| | - Alejandro González-Ojeda
- />Research Unit in Clinical Epidemiology, Medical Unit of High Specialty, Specialties Hospital of the Western Medical Center, Mexican Institute of Social Security, Avenida Belisario Domínguez 1000, Colonia Independencia, CP 44340 Guadalajara, Jalisco México
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Ambriz-González G, Velázquez-Ramírez GA, García-González JL, de León-Gómez JMG, Muciño-Hernández MI, González-Ojeda A, Basterra JV. Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications. Urol Int 2007; 78:37-41. [PMID: 17192730 DOI: 10.1159/000096932] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 04/26/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urethrocutaneous fistulas (UCF) and flap dehiscence (FD) are the most common postoperative complications after hypospadias (HS) surgical repair. The aim of this study was to evaluate whether the application of fibrin sealant over the site of surgery and suture lines reduces these complications. MATERIALS AND METHODS A prospective cohort of consecutive patients was treated over a 3-year period. 30 patients were submitted to HS surgical repair plus application of fibrin glue over the suture line and surgical site; for comparison, another 56 subjects made up the control group which was submitted to surgical repair only. Variables assessed included: age, type of HS, fibrin sealant used, complications and number of surgical procedures required to treat recurrences. RESULTS In general, the frequency of complications was 10 vs. 41% for UCF (p = 0.002), 13 vs. 50% for FD (p = 0.001), and for flap necrosis (FN) 6.7 vs. 28.6% (p = 0.01) for the treatment and control groups respectively. The number of surgical reinterventions to treat recurrences was higher in the control group than in the study group (p = 0.04). CONCLUSION The incidence of UCF after HS surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines.
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Sanders C. Comparison of dressing removal following hypospadias repair. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2003; 12:S21-8. [PMID: 12937382 DOI: 10.12968/bjon.2003.12.sup3.11433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 11/11/2022]
Abstract
Hypospadias occurs when the urethral folds fail to fuse on the ventral aspect of the penis (Thomas and Barker, 1997). Surgical repair is often warranted and standard postoperative practice in the UK often includes the application of a dressing around the penis. This article reports the outcome of a small randomized controlled feasibility study to compare two methods of dressing removal following hypospadias repair. The same dressing was used throughout the study--a control group used a standard method of dressing removal, while an experimental group had an additional barrier film applied before the dressing was attached to the wound. The primary outcome measure was the time taken to remove the dressing. The time interval between starting the process of dressing removal and having no dressing left in place was used for statistical analysis. Secondary measures included assessment of the child's pain at different intervals by the parents and by an independent nurse observer. General discussion took place with the parents regarding any experience of anxiety. This was to assess whether parental anxiety should be measured in a future randomized controlled trial (RCT). There appeared to be implications with regard to time savings with the new method of dressing removal. Issues about the most suitable environment to remove dressing and differences between pain assessments of nurse and parent are noted. This was only a small-scale study. To investigate these issues more fully, a RCT has since been developed, has gained ethical approval and is due to start in August 2003.
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