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Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'

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Dr Mujtuba Pervez Khan
Dr Mujtuba Pervez Khan

This study compared using autologous platelet-rich plasma (PRP) versus a dartos flap for covering the urethra after distal hypospadias repair using the Snodgrass technique. The randomized study of 180 patients found no significant difference in operative time between the PRP and dartos flap groups. Post-operative complication rates and cosmetic results were also similar between the two covering methods. The study concluded that PRP could be a low-cost alternative to other tissue grafts for urethral coverage after hypospadias repair.

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Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study Abdelaziz Yehya Mahmoud, Samir Gouda, Ibrahim Gamaan and Mohamed A Baky Fahmy Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt Presenter: Dr Mujtuba Pervez Khan Resident Plastic and Reconstructive Surgery DUHS/CHK
Literature ? Soft tissue coverage over the urethra, important factor affecting the outcome ? Protective layer between the neo-urethra and the skin reduces fistulas and overall complications ? Despite the use of covering flaps in hypospadias surgery, it is still a matter of debate by some authors. ? PRP is an autologous concentrate of platelets in a small volume of plasma containing biologically active factors responsible for hemostasis, synthesis of new connective tissue and revascularization
PRP for hair loss PRP for Arthritis
PRP for wounds
PRP for Alveolar Cleft
Discussion ? >250 techniques have been reported ? Fistula rate varies from 3 to 10% ? Different techniques for second layer coverage ? No accordance among pediatric urologists on the most effective technique
Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'
Tunica vaginalis Buccal / Lower lip mucosa graft
Dartos layer Fibrin glue layer Spongioplasty
Aim ? To evaluate and to compare the use of PRP covering layer and dartos flap layer in regard to complication rates in Snodgrass (TIP) hypospadias repair.
Methods ? RCT ? October 2011 to December 2016 ? Total 180 patients ? Mean age 27.9 months ? Randomization was achieved through sealed envelopes
? Group A (n= 90) ? PRP layer group ? Lost to follow up = 3 ? Group B (n= 90) ? Dartos flap group ? Lost to follow up = 5
Inclusion Criteria ? Primary cases ? Sub coronal, distal and mid penile with minimal chordee Exclusion Criteria ?Proximal hypospadias ?UCF ?Moderate to severe chordee ?Previous topical androgen therapy
Parameters ? Operative time ? Early and late post op complications ? Urinary stream ? Aesthetic appearance
Operative Procedure ? 10cc blood drawn ? PRP extracted by double centrifuge ? Calcium chlorate was added ? Incubated at 37C for 3 mins until red clot was obtained
Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'
Operative Procedure ? PRP sheet was applied (vicryl 7/0) after tubularization (vicryl 6/0) ? Skin was closed ? 8 -12 F catheter was used ? Dressing removed on 4th P.O.D ? Catheter kept for 7-10 days ? Urinary stream was observed in all patients
Statistical Analysis ? 95% confidence interval ? 80% power of the study ? 5% error ? Chi squared test was applied ? P <0.050 was considered significant
Results
Results ? A, PRP group = 124.6 minutes ? B, Dartos group = 136.4 minutes ? P >0.10, statistically insignificant Operative time
Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'
Results ? A slit-like neo-meatus on the tip of the glans was obtained in most of the cases. ? Parents were asked to evaluate the cosmetic appearance of the penis as good, acceptable, bad or indifferent. The cosmetic result was reported as good in 73% of group A and 69% of group B. Cosmetic appearance
Critique ? Introduction ? Methods ? Statistics ? Results ? Conclusion
Strengths ? No additional cost involved as in fibrin glue ? May be reproducible in out setup
Limitations ? Single center study ? Small randomized study ? Needs comparison with other techniques
In our setup
Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'
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Journal Club 'Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study'

  • 1. Autologous platelet-rich plasma (PRP) covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study Abdelaziz Yehya Mahmoud, Samir Gouda, Ibrahim Gamaan and Mohamed A Baky Fahmy Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt Presenter: Dr Mujtuba Pervez Khan Resident Plastic and Reconstructive Surgery DUHS/CHK
  • 2. Literature ? Soft tissue coverage over the urethra, important factor affecting the outcome ? Protective layer between the neo-urethra and the skin reduces fistulas and overall complications ? Despite the use of covering flaps in hypospadias surgery, it is still a matter of debate by some authors. ? PRP is an autologous concentrate of platelets in a small volume of plasma containing biologically active factors responsible for hemostasis, synthesis of new connective tissue and revascularization
  • 3. PRP for hair loss PRP for Arthritis
  • 6. Discussion ? >250 techniques have been reported ? Fistula rate varies from 3 to 10% ? Different techniques for second layer coverage ? No accordance among pediatric urologists on the most effective technique
  • 8. Tunica vaginalis Buccal / Lower lip mucosa graft
  • 9. Dartos layer Fibrin glue layer Spongioplasty
  • 10. Aim ? To evaluate and to compare the use of PRP covering layer and dartos flap layer in regard to complication rates in Snodgrass (TIP) hypospadias repair.
  • 11. Methods ? RCT ? October 2011 to December 2016 ? Total 180 patients ? Mean age 27.9 months ? Randomization was achieved through sealed envelopes
  • 12. ? Group A (n= 90) ? PRP layer group ? Lost to follow up = 3 ? Group B (n= 90) ? Dartos flap group ? Lost to follow up = 5
  • 13. Inclusion Criteria ? Primary cases ? Sub coronal, distal and mid penile with minimal chordee Exclusion Criteria ?Proximal hypospadias ?UCF ?Moderate to severe chordee ?Previous topical androgen therapy
  • 14. Parameters ? Operative time ? Early and late post op complications ? Urinary stream ? Aesthetic appearance
  • 15. Operative Procedure ? 10cc blood drawn ? PRP extracted by double centrifuge ? Calcium chlorate was added ? Incubated at 37C for 3 mins until red clot was obtained
  • 17. Operative Procedure ? PRP sheet was applied (vicryl 7/0) after tubularization (vicryl 6/0) ? Skin was closed ? 8 -12 F catheter was used ? Dressing removed on 4th P.O.D ? Catheter kept for 7-10 days ? Urinary stream was observed in all patients
  • 18. Statistical Analysis ? 95% confidence interval ? 80% power of the study ? 5% error ? Chi squared test was applied ? P <0.050 was considered significant
  • 20. Results ? A, PRP group = 124.6 minutes ? B, Dartos group = 136.4 minutes ? P >0.10, statistically insignificant Operative time
  • 22. Results ? A slit-like neo-meatus on the tip of the glans was obtained in most of the cases. ? Parents were asked to evaluate the cosmetic appearance of the penis as good, acceptable, bad or indifferent. The cosmetic result was reported as good in 73% of group A and 69% of group B. Cosmetic appearance
  • 23. Critique ? Introduction ? Methods ? Statistics ? Results ? Conclusion
  • 24. Strengths ? No additional cost involved as in fibrin glue ? May be reproducible in out setup
  • 25. Limitations ? Single center study ? Small randomized study ? Needs comparison with other techniques