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Journal of Indian Association of Pediatric Surgeons
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LETTERS TO THE EDITOR
Year : 2019  |  Volume : 24  |  Issue : 3  |  Page : 226-227
 

Cryocalcium glue in hypospadias surgery


1 Department of Pediatric Surgery, Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran

Date of Web Publication6-Jun-2019

Correspondence Address:
Dr. Mehrdad Hosseinpour
Imam Hossein Children Hospital, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_159_18

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How to cite this article:
Hosseinpour M, Etezazian S, Hamsaieh M. Cryocalcium glue in hypospadias surgery. J Indian Assoc Pediatr Surg 2019;24:226-7

How to cite this URL:
Hosseinpour M, Etezazian S, Hamsaieh M. Cryocalcium glue in hypospadias surgery. J Indian Assoc Pediatr Surg [serial online] 2019 [cited 2019 Jun 26];24:226-7. Available from: http://www.jiaps.com/text.asp?2019/24/3/226/259753




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.
Table 1: Postoperative complications in groups

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[Figure 1] shows the microscopic process of red blood cell aggregation after 5 min.
Figure 1: Microscopic process of red blood cell aggregation after 5 min

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The interposition of a layer of healthy tissue between the urethroplasty and skin is essential in the surgical repair of hypospadias, and use of fibrin glue in the repair of hypospadias seems to reduce the incidence of fistula formation. Reduction of fistula rate by using fibrin glue was reported in a prospective randomized trial of 120 boys with proximal hypospadias undergoing TIPS procedure. Fistulas were found in 10% of cases with fibrin glue versus 30% without glue.[1]

Commercially available fibrin glue was prepared from pooled cryoprecipitated fibrinogen from multiple plasma donates and although donor screening, heat-treating, and use of solvent and detergent suspension have made these products safer, the possible risk of transmission of infections and high cost of commercially available glue led to limit the use of this sealant in underdeveloped or developing countries. Cryocalcium glue preparation is very simple as compared to that of fibrin glue and can be prepared during urethroplasty procedure and used immediately.

The incidence of fistula in our series was very lower in the case group, and these results showed that cryocalcium glue is a safe and inexpensive alternative for commercially used fibrin glue for reduction of fistula formation. The mechanism seems to be related to additional layer formation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gopal SC, Gangopadhyay AN, Mohan TV, Upadhyaya VD, Pandey A, Upadhyaya A, et al. Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair. J Pediatr Surg 2008;43:1869-72.  Back to cited text no. 1
    
2.
Barbagli G, De Stefani S, Sighinolfi MC, Annino F, Micali S, Bianchi G, et al. Bulbar urethroplasty with dorsal onlay buccal mucosal graft and fibrin glue. Eur Urol 2006;50:467-74.  Back to cited text no. 2
    
3.
Moein H, Mohagheghzadeh P, Khalili HA. Cryocalcium glue: A new formation for dural repair augmentation. J Res Med Sci 2005;10:139-41.  Back to cited text no. 3
    
4.
Agrain Y, Cheikheelard A, Lottman H, Lortat-Jacob S. Hypospadias: surgery and complications. Horm Res Paeditr 2010; 74: 218- 22.  Back to cited text no. 4
    
5.
Sunay M, Dadali M, Karabulut A, Emir L, Erol D. Our 23-year experience in urethrocutaneous fistulas developing after hypospadias surgery. Urology 2007;69:366-8.  Back to cited text no. 5
    


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