الفهرس 
HealingOnly 14 pages are availabe for public view
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Abstract
PRP has been expressing promising results in healing promotion since its usage in in-situ regenerative therapy techniques in surgery, orthopaedics, and sports medicine. We usedthe results of hypospadias repair with PRPg in comparison to the results of hypospadias repair without PRPto prove the paramount role of PRP in healing, limitation of post-operative complications, and enhancement of cosmosis.
The prevalence of hypospadias is estimated to be 11.3 of 10000 to affect less than 0.1% of newborns worldwide. The etiology of hypospadias is multifactorial; environmental factor, genetic factors, maternal-placental factors, in addition to prenatal insufficient hormonal stimulation. Several repair techniques have been developing to improve the outcomes including tissue healing, and to reduce the risk of complications including stenosis glans dehiscence, hematoma, phimosis, fistula, infection, graft retraction and edema.
In arandomized prospective controlled study, we included 60 children who aged between 6 months and 12 years. During two years, we recruited patients from Pediatric Surgery department at Ain Shams University Hospital, and Pediatric surgery unit at Suez Canal University Hospital. The study aim was achieved through assessment of the patients’ characteristics, intraoperative measures and comparison of the rate of complications of autologous PRPg versus TIP in hypospadias repair. In this study we divided the study population into two groups as following: group 1A: we used TIP repair with autologous PRP gel; group 1B: we used TIP repair without autologous PRP gel; group 2A: we used buccal mucosa or foreskin graft as first stage with autologous PRP gel; and group 2B: we used buccal mucosa or foreskin graft as first stage without autologous PRP gel.
The majority of participants at groups 1A and B aged between 6 to 24 months. While the most of participants at groups 2A and 2B aged between 2 to 6 years old.
Most of the children in group 1A and B had distal shaft hypospadias, followed by mid-shaft hypospadias. On the other hand, the majority of children at groups 1B and 2A had penosacral hypospadias, followed by proximal shaft. Almost all children had hypospadias repair for the first time, except for 10 children, 27% of them were in group 1A.
The mean operation time was longer in group 2A, with a mean of 192 minutes. Two types of grafts were used in groups 2A and 2B; buccal and foreskin. The latter type was the most commonly used in both groups. We used tubes of silicon with all patients. Foreskin graft was used frequently with all types of hypospadias, except perineal type where buccal graft was commonly used.
All patients in group 1A and 1B had slit-like meatus shape in the distal glans. While all those of group 1A had one urine stream, yet 11 of group 1B had one. There were complications that happened exclusively in group B such as spray stream (27%), and fistula (20%) Whereas the rest of complications occurred more with group 1B than in 1A including meatal stenosis (53 versus 27%), glans dehiscence, (20 versus 7%), bleeding (33 versus 13%), infection (33 versus 27%), Edema occurred in only 13% and 27% of those in group 1A and 1B, respectively.
However, skin necrosis occurred in 7% of group 1A and group 1B. The total number of reported complications among group 1A was less than half of that reported among group B.
Concerning group 2A and 2B, most of the complications occurred with group 2B. For instance graft infection happened in 13% of group 2B versus 0% in group 2A. Unlike group 2B, all patients in group C experienced graft taking, while 2 of group 2A did not. All patients at group 2A and 2B had edema. The total number of reported complications among group 2A was quite similar; however less than that reported among group 2B.
Autologous PRP demonstrated a lower rate of complications, in addition to better healing abilities without exposing the wound to risks of infections, hematoma, and bleeding; also it can be used in the second stage of repair.
Also the use of PRP gives tissue good quality that evident in graft surgery and offers the ability to overcome post-operative complications especially infection
One of the advantages of the proposed intervention is that the used PRP is autologous, which is easier and less expensive, moreover, reduces the risk of infections, allergic reactions and bleeding.
On the other hand, this technique was limited by the need for another team, the laboratory equipment, and the required personnel experience to prepare PRP, which made it a time and money consuming technique also there is no standardization of the use of PRP in medicine and surgery. Other limitations to our study were not performing the second stage of repair for group 2; this resulted in underestimated results. Besides, we combined diverse types of hypospadias in each group; albeit, we tried our best to match all the other features of the study participants to attain bias-free findings. We also were limited by a small sample size and short study period; thus a longer duration study with larger sample size is highly recommended.
CONCLUSION
PRP usage expresses promising results as a healing promoter, additionally, it provides a coverage layer in surgical fields. PRP showed better results when used in hypospadias repair where we witnessed low incidence of postoperative complications. We concluded that the incidence of complications was higher among the groups who did not receive autologous PRP gel. This proves that PRP can be a reliable material to induce wound healing and to limit of postoperative surgical complications.
PRP is advisable method for local wound management; PRP can improve wound healing and reduce risk of infection.
Autologous origin of PRP, uncomplicated and inexpensive preparation of PRP makes PRP promising method for the use in surgery