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Nicol Bush*, Warren Snodgrass, Frisco, TX

INTRODUCTION AND OBJECTIVES: Patients with multiply failed hypospadias repairs may have decreased penile vascularity and impaired wound healing. Hyperbaric oxygen therapy (HBOT) is known to increase neovascularity and promote wound healing. We evaluated the effect of preoperative HBOT on oral graft take in hypospadias cripples.

METHODS: We have measured graft sizes in all patients undergoing staged tubularized autograft (STAG) repairs at the first and second stages since May 2015. This study included patients with 2 or more failed repairs undergoing oral graft STAG reoperation. HBOT was recommended for those with ≥3 failed surgeries, comprising a total of 20 preop dives and 10 postop dives at 2atm and 100% FiO2. Not all patients undergoing reoperative STAG repair met this criteria, and some recommended for HBOT did not receive treatment due to social and/or insurance purposes. Patients were divided into those who did and did not undergo therapy. Graft length was measured from glans tip to the proximal urethrostomy. Graft width was measured at the corona, mid portion and just above the proximal urethrostomy. Graft area (mm2) was calculated as length x average width. Percent graft contracture was calculated by 100-(area 1/area 2) x 100. Contracture ≥50% was considered significant.

RESULTS: 37 patients (mean age 15 years) met inclusion criteria, 15 without and 22 with HBOT. Despite similar baseline criteria (Table), patients with preoperative HBOT therapy had less graft contracture (9% vs. 26%) even though they had a greater number of prior surgeries (3.7 vs. 2.6). Only 5% had graft contracture ≥50% vs. 40% of those who did not undergo preop HBOT (p=0.01). Of the 6 patients with graft contracture ≥50%, 2 required repeat grafting before 2nd stage tubularization.

CONCLUSIONS: There was less oral graft contracture overall, and less contracture ≥50%, in patients undergoing salvage STAG repair who received HBOT than in those who did not, even though treated patients had a significantly greater number of prior failed repairs. In addition, grafts following treatment were subjectively more robust and elastic, facilitating their tubularization. This is the first study to show objective improvement in hypospadias wound healing using HBOT for high risk patients.

Source of Funding: None

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