Treatment of distal hypospadias using autologous platelet-rich plasma
https://doi.org/10.21886/2308-6424-2025-13-4-47-54
Abstract
Hypospadias is the most prevalent congenital malformation of the male urogenital tract and the most common penile anomaly. This literature review delineates the most frequently performed hypospadias repair techniques and highlights the evolving paradigms in its surgical management. In recent years, significant attention has been directed towards the application of adjunctive biomaterials in hypospadias surgery. These materials are employed to provide an additional layer over the neourethra and the suture lines, particularly in cases where optimal local tissues, such as the dartos fascia or tunica vaginalis, are deficient or unavailable. Analysis of published evidence and statistical data indicates that autologous platelet concentrates, specifically Platelet-Rich Plasma (PRP), yield the most favourable outcomes. The use of PRP presents novel avenues for advancement in urethral reconstructive surgery. Investigations into its mechanism of action suggest that PRP can stimulate tissue regeneration, modulate anti-inflammatory responses to expedite wound healing, promote neoangiogenesis within the affected tissues, and enhance their vascularisation. This evidence points to the potential efficacy of topical PRP application in managing patients with compromised wound-healing potential and significant alterations in the morpho-functional characteristics of the urethral tissues.
About the Authors
N. R. Akramov
Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional
Education; Kazan Republican Clinical Hospital; Dion Medical Group, LLC
Russian Federation
Russian Federation
Nail R. Akramov – Dr.Sc.(Med), Full Prof.
Kazan
B. M. Shaikhraziev
Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional
Education; Kazan Republican Clinical Hospital
Russian Federation
Russian Federation
Bulat M. Shaykhraziev
Kazan
R. T. Batrutdinov
Ava-Peter Scandinavia Clinic
Russian Federation
Russian Federation
Ruslan T. Batrutdinov – Cand.Sc.(Med.)
Saint-Petersburg
I. N. Khusnullin
Kazan State Medical Academy — Branch Campus of the Russian Medical Academy of Continuous Professional
Education
Russian Federation
Russian Federation
Iskander N. Khusnullin
Kazan
References
1. Keays M.A., Dave S. Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J. 2017;11(1-2Suppl1):S48-S53. DOI: 10.5489/cuaj.4386
2. Retik A.B., Atala A. Complications of hypospadias repair. Urol Clin North Am. 2002;29(2):329-339. DOI: 10.1016/s0094-0143(02)00026-5
3. Bouty A., Ayers K.L., Pask A., Heloury Y., Sinclair A.H. The Genetic and Environmental Factors Underlying Hypospadias. Sex Dev. 2015;9(5):239-259. DOI: 10.1159/000441988
4. Суров Р.В., Каганцов И.М. Хирургическое лечение гипоспадии у детей: фундаментальные основы и новейшие тенденции. Андрология и генитальная хирургия. 2017;18(4):34-42.
5. Surov R.V., Kagantsov I.M. Hypospadias repair in children: fundamental principles and latest tendencies. Andrology and Genital Surgery. 2017;18(4):34-42. (In Russian). eLIBRARY ID: 32327022; EDN: YMRLIZ
6. Canon S., Mosley B., Chipollini J., Purifoy J.A., Hobbs C. Epidemiological assessment of hypospadias by degree of severity. J Urol. 2012;188(6):2362-2366. DOI: 10.1016/j.juro.2012.08.007
7. Springer A., van den Heijkant M., Baumann S. Worldwide prevalence of hypospadias. J Pediatr Urol. 2016;12(3):152.e1-7. DOI: 10.1016/j.jpurol.2015.12.002
8. Joodi M., Amerizadeh F., Hassanian S.M., Erfani M., Ghayour-Mobarhan M., Ferns G.A., Khazaei M., Avan A. The genetic factors contributing to hypospadias and their clinical utility in its diagnosis. J Cell Physiol. 2019;234(5):5519-5523. DOI: 10.1002/jcp.27350
9. Райгородская Н.Ю., Болотова Н.В., Морозов Д.А., Поляков В.К., Цмокалюк Е.Н. Морфофункциональная характеристика гонад у детей с различными вариантами нарушения формирования пола в период мини-пубертата. Педиатрия. Журнал им. Г.Н. Сперанского. 2016;95(1):46-50.
10. Raigorodskaya N.Y., Bolotova N.V., Morozov D.A., Polyakov V.K., Tsmokalyuk E.N. Morphofunctional characteristics of gonads in children with different types of sex development disorders during mini puberty. Pediatriya. Zhurnal im G.N. Speranskogo. 2016;95(1):46-50. (In Russian) eLIBRARY ID: 25591365; EDN: VOAKMR
11. Николаев В.В., Солонцов Ю.Н. Эпидемиология и теории происхождения гипоспадии. Урология. 2018;(3):141-145.
12. Nikolaev V.V., Solontsov Yu.N. Epidemiology and theories of the origin of hypospadias. Urologiia. 2018;(3):141-145. (In Russian). DOI: 10.18565/urology.2018.3.141-145
13. Schnack T.H., Zdravkovic S., Myrup C., Westergaard T., Christensen K., Wohlfahrt J., Melbye M. Familial aggregation of hypospadias: a cohort study. Am J Epidemiol. 2008;167(3):251-256. DOI: 10.1093/aje/kwm317
14. Rodríguez Fernández V., López Ramón Y., Cajal C., Marín Ortiz E., Sarmiento Carrera N. Accurate Diagnosis of Severe Hypospadias Using 2D and 3D Ultrasounds. Case Rep Obstet Gynecol. 2016;2016:2450341. DOI: 10.1155/2016/2450341
15. Николаев В.В., Солонцов Ю.Н., Протасов А.А. Роль плацентарных расстройств среди факторов риска возникновения изолированной гипоспадии. Детская хирургия. 2018;22(6):288-291.
16. Nikolaev V.V., Solontsov Y.N., Protasov A.A. The role of placental disorders among risk factors in the formation of isolated hypospadias. Russian Journal of Pediatric Surgery. 2018;22(6):288-291. (In Russian). DOI: 10.18821/1560-9510-2018-22-6-288-291
17. Райгородская Н.Ю., Болотова Н.В., Морозов Д.А., Седова Л.Н., Захарова Н.Б., Иваненко И.Л., Белкова О.Л. Половое развитие мальчиков с гипоспадией. Урология. 2013;(2):88-93.
18. Raygorodskaya N.Yu., Bolotova N.V., Morozov D.A., Sedova L.N., Zakharova N.B., Ivanenko I.L., Belkova O.L. Sexual development of boys with hypospadias Urologiia. 2013;(2):88-93. (In Russian). eLIBRARY ID: 19049069; EDN: QAWCYZ
19. Bauer S.B., Retik A.B., Colodny A.H. Genetic Aspects of Hypospadias. Urologic Clinics of North America. 1981;8(3):559-564. DOI: 10.1016/S0094-0143(21)01313-6
20. Sun G., Tang D., Liang J., Wu M. Increasing prevalence of hypospadias associated with various perinatal risk factors in chinese newborns. Urology. 2009;73(6):1241-1245. DOI: 10.1016/j.urology.2008.12.081
21. Main K.M., Jensen R.B., Asklund C., Høi-Hansen C.E., Skakkebaek N.E. Low birth weight and male reproductive function. Horm Res. 2006;65 Suppl 3:116-122. DOI: 10.1159/000091516
22. Roberts C.J., Lloyd S. Observations on the epidemiology of simple hypospadias. Br Med J. 1973;1(5856):768-770. DOI: 10.1136/bmj.1.5856.768
23. Stein R. Hypospadias. Eur. Urol. Suppl. 2012;(11):33-45.
24. Duckett J.W. Jr. Hypospadias. Pediatr Rev. 1989;11(2):37-42. DOI: 10.1542/pir.11-2-37
25. Hadidi A.T. History of hypospadias: Lost in translation. J Pediatr Surg. 2017;52(2):211-217. DOI: 10.1016/j.jpedsurg.2016.11.004
26. Belman AB. Hypospadias update. Urology. 1997;49(2):166-172. DOI: 10.1016/S0090-4295(96)00567-5
27. Cooper C.S., Snyder H.M. Pediatric reconstructive surgery. Curr Opin Urol. 2000;10(3):195-199. DOI: 10.1097/00042307-200005000-00002
28. Diamond D.A., Chan I.H.Y., Holland A.J.A., Kurtz M.P., Nelson C., Estrada C.R. Jr, Bauer S., Tam P.K.H. Advances in paediatric urology. Lancet. 2017;390(10099):1061-1071. DOI: 10.1016/S0140-6736(17)32282-1
29. Springer A. Assessment of outcome in hypospadias surgery – a review. Front Pediatr. 2014;2:2. DOI: 10.3389/fped.2014.00002
30. Snodgrass W., Bush N. Primary hypospadias repair techniques: A review of the evidence. Urol Ann. 2016;8(4):403-408.DOI: 10.4103/0974-7796.192097
31. Springer A., Tekgul S., Subramaniam R. An Update of Current Practice in Hypospadias Surgery. European Urology Supplements. 2017;16(1):8-15. DOI: 10.1016/j.eursup.2016.09.006
32. Duplay S. De L'Hypospadais Perineo-Scrotal Et De Son Traitement Chirurgical. Paris: Asselin; 1874:657-682.
33. Mathieu P. Traitment en un temps de l'hypospadias balanique et juxtablanique. J. Chir. (Paris). 1932;39:481-486.
34. Thiersch K. Ueber die Ensteungsweise und operative Behandlung der Epispadie. Arch. Heilk. 1869;(10):26-31.
35. Snodgrass W. Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994 Feb;151(2):464-5. DOI: 10.1016/s0022-5347(17)34991-1
36. Hayashi Y., Kojima Y. Current concepts in hypospadias surgery. Int J Urol. 2008;15(8):651-664. DOI: 10.1111/j.1442-2042.2008.02081.x.
37. Hodgson N.B. A one-stage hypospadias repair. J Urol. 1970;104(2):281-283. DOI: 10.1016/s0022-5347(17)61718-x
38. Bracka A. Hypospadias repair: the two-stage alternative. Br J Urol. 1995;76 Suppl 3:31-41. DOI: 10.1111/j.1464-410x.1995.tb07815.x
39. Hayes M.C., Malone P.S. The use of a dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int. 1999 Mar;83(4):508-9. DOI: 10.1046/j.1464-410x.1999.00043.x
40. Beck C. A new operation for balanic hypospadias. NY Med. J. 1898;67:147-148.
41. Koff S.A. Mobilization of the urethra in the surgical treatment of hypospadias. J Urol. 1981;125(3):394-397. DOI: 10.1016/s0022-5347(17)55048-x
42. Акрамов Н.Р., Каганцов И.М., Хаертдинов Э.И. Дистензионные методы хирургической коррекции гипоспадии у мальчиков. Казанский медицинский журнал. 2021;102(2):216-227.
43. Akramov N.R., Kagantsov I.M., Khaertdinov E.I. Distension methods of surgical correction of hypospadias in boys. Kazan medical journal. 2021;102(2):216-227. (In Russian). DOI: 10.17816/KMJ2021-216
44. Акрамов Н.Р., Каганцов И.М., Сизонов В.В., Батрутдинов Р.Т., Дубров В.И., Хаертдинов Э.И. Новый вариант техники перемещающей уретропластики с нерасчленяющей спонгиопластикой при дистальных формах гипоспадии у детей. Вестник урологии. 2020;8(3):5-12.
45. Akramov N.R., Kagantsov I.M., Sizonov V.V., Batrutdinov R.T., Dubrov V.I., Khaertdinov E.I. Advancement urethroplasty for distal hypospadias repair without dismembering urethra spongy body and glans penis. Urology Herald. 2020;8(3):5-12. (In Russian)/ DOI: 10.21886/2308-6424-2020-8-3-5-12
46. Duckett J.W. MAGPI (meatoplasty and glanuloplasty): a procedure for subcoronal hypospadias. Urol Clin North Am. 1981;8(3):513-519. PMID: 7324318
47. Lin D., Wang G., Song H., Qu Y., Liu P., Liang H., Xu S., Chen S., Zhang W., Zhao Y., Chen B., Sun N. Use of Acellular Dermal Matrix for Urethroplasty Coverage in Proximal Hypospadias Repair: a Pilot Study. Adv Ther. 2020;37(4):1425-1435. DOI: 10.1007/s12325-020-01254-9
48. Gopal S.C., Gangopadhyay A.N., Mohan T.V., Upadhyaya V.D., Pandey A., Upadhyaya A., Gupta D.K. Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair. J Pediatr Surg. 2008;43(10):1869-1872. DOI: 10.1016/j.jpedsurg.2008.04.022
49. Guinot A., Arnaud A., Azzis O., Habonimana E., Jasienski S., Frémond B. Preliminary experience with the use of an autologous platelet-rich fibrin membrane for urethroplasty coverage in distal hypospadias surgery. J Pediatr Urol. 2014;10(2):300-305. DOI: 10.1016/j.jpurol.2013.09.026
50. Anand S., Özbey H., Sharma S. Looking beyond the dartos fascia and tunica vaginalis: reviewing the stance of common adjuvant covering biomaterials in hypospadiology. Am J Clin Exp Urol. 2022;10(2):111-118 PMID: 35528465; PMCID: PMC9077145.
51. Elsayem K., Darwish A.S., AbouZeid A.A., Kamel N., Dahab M.M., El-Naggar O. Autologous platelet gel improves outcomes in tubularized incised plate repair of hypospadias. J Pediatr Surg. 2022;57(3):488-491. DOI: 10.1016/j.jpedsurg.2021.03.058
52. Попов С.В., Орлов И.Н., Топузов Т.М., Горелик М.Л., Перфильев М.А., Котлов М.А. Применение обогащённой тромбоцитами плазмы (PRP) в урологической практике. Вестник урологии. 2023;11(1):134-142.
53. Popov S.V., Orlov I.N., Topuzov T.M., Gorelik M.L., Perfil’yev M.A., Kotlov M.A. The use of platelet-rich plasma (PRP) in urology. Urology Herald. 2023;11(1):134-142. (In Russian). DOI: 10.21886/2308-6424-2023-11-1-134-142
54. Scarcia M., Maselli F.P., Cardo G., Ludovico G.M. The use of autologous platelet rich plasma gel in bulbar and penile buccal mucosa urethroplasty: Preliminary report of our first series. Arch Ital Urol Androl. 2016;88(4):274-278. DOI: 10.4081/aiua.2016.4.274
55. Galliera E., Corsi M.M., Banfi G. Platelet rich plasma therapy: inflammatory molecules involved in tissue healing. J Biol Regul Homeost Agents. 2012;26(2 Suppl 1):35S-42S. PMID: 23648197
56. Randelli P., Randelli F., Ragone V., Menon A., D'Ambrosi R., Cucchi D., Cabitza P., Banfi G. Regenerative medicine in rotator cuff injuries. Biomed Res Int. 2014;2014:129515. DOI: 10.1155/2014/129515
57. Alio J.L., Abad M., Artola A., Rodriguez-Prats J.L., Pastor S., Ruiz-Colecha J. Use of autologous platelet-rich plasma in the treatment of dormant corneal ulcers. Ophthalmology. 2007;114(7):1286-1293.e1. DOI: 10.1016/j.ophtha.2006.10.044
58. Dhurat R., Sukesh M. Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective. J Cutan Aesthet Surg. 2014;7(4):189-197. DOI: 10.4103/0974-2077.150734
59. Man D., Plosker H., Winland-Brown J.E. The use of autologous plateletrich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cosmetic surgery. Plast Reconstr Surg. 2001;107(1):229-237; discussion 238-239. DOI: 10.1097/00006534-200101000-00037
60. Soyer T., Çakmak M., Aslan M.K., Şenyücel M.F., Kisa Ü. Use of autologous platelet rich fibrin in urethracutaneous fistula repair: preliminary report. Int Wound J. 2013;10(3):345-347. DOI: 10.1111/j.1742-481X.2012.00983.x
61. Mahmoud A.Y., Gouda S., Gamaan I., Baky Fahmy M.A. Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study. Int J Urol. 2019;26(4):475-480. DOI: 10.1111/iju.13912
62. Nishinaka K. Editorial Comment to Autologous platelet-rich plasma covering urethroplasty versus dartos flap in distal hypospadias repair: A prospective randomized study. Int J Urol. 2019;26(4):480. DOI: 10.1111/iju.13920
63. Eryilmaz R., Şimşek M., Aslan R., Beger B., Ertaş K., Taken K. The effect of plasma rich platelet graft on post-operative complications in midpenile hypospadias. Andrologia. 2020;52(7):e13652. DOI: 10.1111/and.13652
64. Moran G.W., Kurtzman J.T., Carpenter C.P. Biologic adjuvant urethral coverings for single-stage primary hypospadias repairs: A systematic review and pooled proportional meta-analysis of postoperative urethrocutaneous fistulas. J Pediatr Urol. 2022;18(5):598-608. DOI: 10.1016/j.jpurol.2022.08.015
65. Abdelazim O., Abdullateef K.S., Khedr E., Tarek M. The use of an autologous platelet-rich fibrin membrane in urethroplasty for cases of distal hypospadias. Egypt Pediatric Association Gaz. 2024;72:58. DOI: 10.1186/s43054-024-00304-z
66. Медведев В.Л., Коган М.И., Михайлов И.В., Лепетунов С.Н. Аутологичная плазма, обогащённая тромбоцитами: что это и для чего? Вестник урологии. 2020;8(2):67-77.
67. Medvedev V.L., Kogan M.I., Mihailov I.V., Lepetunov S.N. Plateletrich autologous plasma: what is it and for what? Urology Herald. 2020;8(2):67-77. (In Russian). DOI: 10.21886/2308-6424-2020-8-2-67-77
Review
For citations:
Akramov N.R., Shaikhraziev B.M., Batrutdinov R.T., Khusnullin I.N. Treatment of distal hypospadias using autologous platelet-rich plasma. Urology Herald. 2025;13(4):47-54. (In Russ.) https://doi.org/10.21886/2308-6424-2025-13-4-47-54
Views:
204
Email this article 