The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

Abstract

This investigative pilot study was conducted with the objective of evaluating the therapeutic effect of a cream containing hyaluronic acid (HA) and silver-sulfadiazine (Altergen", IBSA Farmaceutici Italia, Sir.l.) in adult patients undergoing two-stage urethroplasty using an oral mucosal graft for anterior urethral strictures due to failed hypospadias repair. We used a cream (Altergen") containing the following active ingredients: 100 g HA, 0.20 mg sodium salt, and 1 g silver-sulfadiazine. During the period of January 2009 -May 2010, 40 patients, mean age 24 years, who had undergone hypospadias surgery during childhood were enrolled in the study, according to some inclusion and exclusion criteria (age >18 years, with the absence of diabetes, neurovascular disease, lichen sclerosus or other dermatological lesions). All 40 patients had navicularis or penile urethral strictures and underwent twostage urethroplasty using an oral mucosa graft. Post-operatively, 20 patients (50%) were treated with a cream containing HA and silver-sulfadiazine (Altergen") and 20 patients (50%) were treated using a standard topical treatment (iodopovidone 10% gel). All patients underwent a follow-up at 6, 15,30,60 and 120 days after surgery. Out of the 20 patients treated with the HA and silver-sulfadiazine-containing cream (Altergen"), 18 (90%) showed good and complete healing of the graft implant 30 days after surgery. Of the 20 patients not treated with the HA and silver-sulfadiazine-contaning cream (Altergen"), 13 (65%) showed good and complete healing of the graft implant 30 days after surgery. These results were constant in all follow-ups in both patient groups. In patients who underwent a navicularis or penile two-stage oral mucosal graft urethroplasty, the use of a HA and silver-sulfadiazine-containing cream was associated with a higher success rate of the graft implant and a lower incidence of post-surgical complications compared to the controls.Repair of navicularis and penile urethral strictures in adult patients is one of the most challenging and difficult problems to deal with in the field of reconstructive urological surgery (1). Moreover, many patients with failed hypospadias repair may require two-stage urethroplasty using an oral mucosa graft (1-2). In the standard two-stage surgical procedure, the oral mucosa graft is sutured to the corpora cavernosa with the aim of building up a sufficiently large urethral plate (first-stage oral mucosa graft urethroplasty) and then is tubularized to the neo-urethra in a second step (second-stage oral

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