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Hyperbaric Oxygen as Adjuvant Therapy after Failed Hypospadias Repair
Christina Kim, M.D., Susan Marai, R.N., Fernando A. Ferrer, Jr., M.D..
Connecticut Children's Medical Center, Hartford, CT, USA.

BACKGROUND:
Hyperbaric oxygen (HBO) accelerates wound healing by increasing tissue microcirculation, decreasing capillary pressure and reducing tissue edema. The use of HBO in urologic surgery has been reported in patients with fournier’s gangrene, hemorrhagic cystitis, and interstitial cystitis. If a patient has a failed hypospadias repair, their treatment is complex because the penis is densely scarred, immobile, hypovascular or significantly shortened. To overcome these healing barriers, we used postoperative HBO. Our primary goal was to improve tissue dynamics and surgical outcomes.
METHODS:
After obtaining IRB approval, we performed a retrospective case series on all patients who received HBO treatment after surgery for a failed hypospadias repair. All patients received pre-therapy consultation by the wound healing service. The treatment protocol was modified from the Hyperbaric Oxygen Therapy Committee Report for skin flaps and grafts from 2003. Specifically, each treatment consisted of exposure to 100% oxygen at 2.4 times atmospheric pressure (2.4 ATA) for 90 minutes.
RESULTS:
Five patients were identified. Original hypospadias location was proximal in 4 and distal in 1. Initial surgeries included tubularized island flap (1), tubularized incised plate (2) and a two stage repair (2). Median number of surgeries per patient was 3.2. Median follow up was 9 months. All five patients were voiding with a straight stream and good flow on follow up. Unfortunately, one patient did experience a seizure during a treatment and his HBO therapy was stopped. In follow up, this patient had no subsequent seizure activity or neurological deficits.
CONCLUSIONS:
Our case series is small but marks the first attempt to use HBO as adjuvant therapy for patients with a failed hypospadias repair. Although our initial success rates are high, the long-term outcome has to be determined. We cannot conclude if the high level of success is related to the use of HBO. The one seizure complication holds significant weight when considering a potential role for HBO in future patients.


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