Dados do Trabalho

Título

THERAPEUTIC EFFECTS OF HYPERBARIC OXYGEN THERAPHY TO REDUCE HYPOSPADIA SURGERY COMPLICATIONS: A CASE SERIES

Introdução e Objetivo

Hypospadias are a challenging condition in pediatric urology with high complication rates attributed mainly to graft contraction, dehiscence and fistulas. Repeated and multiple surgeries lead to different degrees of scarring and hypovascularity of penile tissues which may result in poor healing and increasing complication rates with each additional repair.  Hyperbaric oxygen therapy (HBOT) is an established treatment for compromised grafts and is used extensively as a salvage therapy for compromised grafts and ischemic non-healing wounds. Recently many trials suggested that HBOT was able to reduce surgical outcome failure and graft failure rates in complicated hypospadias repair. We present a case series of this subset of patients using HBOT as an adjunctive intervention with the aim of increasing graft take and decreasing complication rates.

Método

Clinical results for 15 patients referred for HBOT at CEBRALE between May 2022 to June 2023 to treat postoperative hypospadias were retrospectively analyzed. Two patients were also submitted to preoperative HBOT sessions. The patient’s clinical files and follow-up consultations were reviewed to assess evolution and outcome.

Resultados

Fifteen patients with a median age of 4.66 years were submitted to an average of 14.6 sessions of HBOT. Two patients were also treated with 10 HBOT sessions before the surgery. 9 patients underwent primary correction surgery whereas 6 patients were reoperation. 13 patients started HBOT right after surgery, on the same day or the day after, while two patients started HBOT treatment 4 and 11 days after surgery, both in the reoperation group. This patient who started HBOT 11 days after surgery already had a dehiscence upon evaluation and didn't achieve total wound healing along with another patient. In this cohort of patients, HBOT was associated with 86.66 % wound healing success. All primary surgery patients achieved total graft take. The HBOT procedure was found to be very effective when initiated shortly after surgery. 

Conclusão

HBOT is safe and well-tolerated in children. 13 out of 15 patients had good graft take with no complications reported. HBOT may serve as an effective complementary treatment in hypospadias patients, in both preoperative and postoperative scenarios. It seems that better results are obtained when HBOT is started right after surgery and reoperations are avoided. A well-designed randomized controlled trial will be conducted by CEBRALE for an optimal comparison between HBOT and control groups.