This study compared using autologous platelet-rich plasma (PRP) versus a dartos flap for covering the urethra after distal hypospadias repair using the Snodgrass technique. The randomized study of 180 patients found no significant difference in operative time between the PRP and dartos flap groups. Post-operative complication rates and cosmetic results were also similar between the two covering methods. The study concluded that PRP could be a low-cost alternative to other tissue grafts for urethral coverage after hypospadias repair.

1. Autologous platelet-rich plasma (PRP) covering
urethroplasty versus dartos flap in distal hypospadias
repair: A prospective randomized
study
Abdelaziz Yehya Mahmoud, Samir Gouda, Ibrahim Gamaan and
Mohamed A Baky Fahmy
Pediatric Surgery Department, Al-Azhar University Hospitals,
Cairo, Egypt
Presenter: Dr Mujtuba Pervez Khan
Resident Plastic and Reconstructive Surgery
DUHS/CHK

2. Literature
 Soft tissue coverage over the urethra, important factor
affecting the outcome
 Protective layer between the neo-urethra and the skin
reduces fistulas and overall complications
 Despite the use of covering flaps in hypospadias surgery, it is
still a matter of debate by some authors.
 PRP is an autologous concentrate of platelets in a small
volume of plasma containing biologically active factors
responsible for hemostasis, synthesis of new connective
tissue and revascularization

3. PRP for hair loss PRP for Arthritis

4. PRP for wounds

5. PRP for Alveolar Cleft

6. Discussion
 >250 techniques have been reported
 Fistula rate varies from 3 to 10%
 Different techniques for second layer coverage
 No accordance among pediatric urologists on the most
effective technique

8. Tunica vaginalis Buccal / Lower
lip mucosa graft

9. Dartos layer
Fibrin glue layer
Spongioplasty

10. Aim
 To evaluate and to compare the use of PRP covering layer
and dartos flap layer in regard to complication rates in
Snodgrass (TIP) hypospadias repair.

11. Methods
 RCT
 October 2011 to December 2016
 Total 180 patients
 Mean age 27.9 months
 Randomization was achieved through sealed envelopes

12.  Group A (n= 90)
 PRP layer group
 Lost to follow up = 3
 Group B (n= 90)
 Dartos flap group
 Lost to follow up = 5

13. Inclusion Criteria
 Primary cases
 Sub coronal, distal and mid penile with minimal chordee
Exclusion Criteria
Proximal hypospadias
UCF
Moderate to severe chordee
Previous topical androgen therapy

14. Parameters
 Operative time
 Early and late post op complications
 Urinary stream
 Aesthetic appearance

15. Operative Procedure
 10cc blood drawn
 PRP extracted by double centrifuge
 Calcium chlorate was added
 Incubated at 37°C for 3 mins until red clot
was obtained

17. Operative Procedure
 PRP sheet was applied (vicryl 7/0)
after tubularization (vicryl 6/0)
 Skin was closed
 8 -12 F catheter was used
 Dressing removed on 4th P.O.D
 Catheter kept for 7-10 days
 Urinary stream was observed in all
patients

18. Statistical Analysis
 95% confidence interval
 80% power of the study
 5% error
 Chi squared test was applied
 P <0.050 was considered significant

19. Results

20. Results
 A, PRP group = 124.6 minutes
 B, Dartos group = 136.4 minutes
 P >0.10, statistically insignificant
Operative time

22. Results
 A slit-like neo-meatus on the tip of the glans was obtained
in most of the cases.
 Parents were asked to evaluate the cosmetic appearance
of the penis as good, acceptable, bad or indifferent. The
cosmetic result was reported as good in 73% of group A
and 69% of group B.
Cosmetic appearance

23. Critique
 Introduction
 Methods
 Statistics
 Results
 Conclusion

24. Strengths
 No additional cost involved as in fibrin glue
 May be reproducible in out setup

25. Limitations
 Single center study
 Small randomized study
 Needs comparison with other techniques

26. In our setup…

28. Thankyou.