Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair

Abstract

BackgroundUrethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery.MethodsThis is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators.ResultsIn the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001).ConclusionIt is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.

Trilayer composite scaffold for urethral reconstruction: in vitro evaluation of mechanical, biological, and angiogenic properties

“…AlloDerm is well established and widely recognized in the field of reconstructive surgery. It was selected as a control material in this study because it is clinically relevant and its value for urethral reconstruction is well documented [47][48][49]. Morphological assessment of the CPC scaffolds revealed a nano/microfibrous structure, which was supportive of cell growth.…”

Acellular dermal matrix in urethral reconstruction

“…Recent research indicates that the utilization of ADM derived from bovine skin as a coverage material for proximal hypospadias repair can effectively decrease the occurrence of urinary fistula formation (89). Wu et al (91) investigated the use of ADM in hypospadias repair and demonstrated a significant reduction in urinary fistula complications without an increased risk of infection and urethral stricture. Given the detrimental effects of urine on the cellular components of tissue-engineered urethra, it is crucial for the scaffold to possess sufficient impermeability as an isolation barrier.…”