Cryocalcium Glue in Hypospadias Surgery

Abstract

Sir, Hypospadias is a congenital abnormality occurring in 1 of 300 live births.[1] Urethrocutaneous fistulas are the most common late complication of hypospadias repair, and their incidence has been used to evaluate the effectiveness of the surgical procedure. Clinical and experimental experiences suggest that fibrin glue prevents urinary extravasation from urological surgical anastomosis,[2,3,4] but sealant is commercially inaccessible and very expensive in some countries. On the other hand, fibrin sealants are blood-derived products and hence allergic risks cannot be totally excluded. In this study, we tried to use cryocalcium glue.[5] We hypothesized that this type of glue may be used to provide an interposition layer during hypospadias repair. Four hundred cases of distal penile hypospadias were selected for the study (300 cases vs. 100 controls). Three hundred cases underwent TIPS urethroplasty (tubularized incised-plate) with application of cryocalcium glue. The control group underwent the same procedure without application of glue. A 1–2 cc blood sample was obtained intraoperatively. In a sterile condition, 5 ml of cryoprecipitate (same as the patient's blood type) and 1 ml of calcium gluconate 10% were mixed with the patient's blood sample for 5 min. This layer was applied over the closure area, and ventral dartos flap was brought over it. Then, another layer of glue was applied, and skin closure was performed. All patients were followed up after 2 weeks of surgery and then 3 monthly. Table 1 shows the various postoperative complications in groups. Urethrocutaneous fistula occurred in five patients of the case group and six patients in the control group (1.6% vs. 6%, P = 0.001). There was no case of allergic reaction in the case group.