Increased complications following failed hypospadias repairs suggest impaired wound healing is a contributing factor. We used perioperative hyperbaric oxygen therapy (HBOT) to promote wound healing determined by graft take in staged tubularized autograft (STAG) reoperations using oral graft. HBOT was recommended in patients having 3 or more failed hypospadias repairs, comprising 20 preoperative and 10 postoperative sessions. All underwent reoperative STAG repair using oral mucosa. Graft length and widths were measured at the time of grafting and again at the 2 stage, from which graft area was calculated. The primary outcomes were percent graft contracture, and graft failure, defined as contracture ≥50%. HBOT patients were compared to other reoperative STAG patients who did not receive therapy. There were 57 patients, 32 receiving HBOT and 25 who had <3 prior repairs or were not able to have treatment due to insurance or lack of local availability. Grafts were healthier with HBOT, having significantly less percent area contracture (9% vs 26%, p=0.04) and graft failure (6% vs 28%, p=0.03) as compared to those not receiving therapy, even though treated patients had significantly more prior failed hypospadias repairs. HBOT improved graft take in hypospadias reoperations. This observation also calls attention to wound healing as another variable to consider in hypospadias surgery.
Bush, Snodgrass (2019). Hyperbaric Oxygen Therapy Improves Oral Graft Take In Hypospadias Stag Reoperations. The Journal of urology, 2019 Feb. https://www.ncbi.nlm.nih.gov/pubmed/30747872