Çocuklarda Hipospadis Cerrahisinde Kanama Kontrolü: Turnike ve Adrenalin

Amaç: Hipospadias yenidoğan penisinde görülen en sık konjenital malformasyonudur. Üretranın hem fizyolojik hem de estetik olarak yeniden şekillendirilmesi, titiz bir ameliyat gerçekleştirmek için iyi bir cerrahi alan görünümü gerektirir. Bu standartları elde etmek için geçmişte turnike uygulaması ve adrenalin enjeksiyonu yapılmıştır ancak en iyi sonucun alınıp alınmadığı konusunda hala tartışmalar devam etmektedir. Gereç ve Yöntem: Çocuk cerrahisi kliniğimizde Kasım 2017-Nisan 2022 tarihleri arasında hipospadias onarımı nedeniyle ameliyat edilen 78 hastanın dosyaları geriye dönük olarak incelendi. Ameliyatlar tek cerrah tarafından tubularize insize plate üretroplasti (TIPU) tekniği kullanılarak gerçekleştirildi. Hipospadias olguları mea yerleşimlerine göre glanüler, distal ve proksimal hipospadias olarak gruplandırıldı. Bu hastalar daha sonra Turnike uygulaması (TA) ve Adrenalin enjeksiyonu (AI) ile komplikasyonları açısından 2 grupta karşılaştırıldı. Bulgular: Çalışma grubumuzda mea yerleşimine bağlı 12 (%15,4) hastada glanüler hipospadias, 58 (%74,4) hastada distal hipospadias ve 8 (%10,2) hastada proksimal hipospadias vardı. Toplamda 12 komplikasyonla karşılaşıldı. Genel komplikasyon oranı %15,3 idi. Mea yerleşiminden bağımsız olarak turnike uygulaması ile adrenalin enjeksiyonu arasındaki komplikasyonlarda istatistiksel olarak anlamlı bulundu. Glanüler, distal ve proksimal hipospadias olguları arasında fark bulunamadı. Sonuç: Geçmişte adrenalin enjeksiyonu tatmin edici sonuçlar vermesine rağmen, çalışmamız hipospadias cerrahisinde turnike uygulamasının hemostazı sağlayan güvenli ve güvenilir bir yöntem olduğunu göstermiştir. Bununla birlikte, en iyi seçeneği belirlemek için daha büyük gruplarla randomize çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Hipospadias, hemostaz, Turnike, Adrenalin, Çocuk

Bleeding Control in Pediatric Hypospadias Surgery: Tourniquet and Adrenaline

Background: Hypospadias is the most encountered congenital malformation of the newborn penis. Refashioning of the urethra, both physiologically and aesthetically, requires a good surgical exposure to perform a scrupulous surgery. To obtain such standards tourniquet application and adrenaline injection have been performed in the past but there is still controversy for the best results. Materials and Methods: The files of 78 patients, who were operated on for hypospadias repair surgery in our pediatric surgery clinic between November 2017 and April 2022, were reviewed retrospectively. Operations were carried out by a single surgeon using tubularized incised plate urethroplasty (TIPU) technique. The hypospadias cases were grouped according to their meatal locations as to glanular, distal and proximal hypospadias. These patients were then compared in 2 groups by Tourniquet application (TA) and Adrenaline injection (AI) regarding their complications. Results: In our study group 12 (15,4%) patients had glanular hypospadias, 58 (74,4%) patients had distal hypospadias and 8 (10,2%) patients had proximal hypospadias relating to meatal locations. 12 complications were encountered in total. The overall complication rate was 15,3%. There was statistical significance in complications between tourniquet application and adrenaline injection irrespective of meatal locations. We found no difference in-between glanular, distal or proximal hypospadias cases. Conclusions: While adrenaline injection has been found with satisfying results in the past, our study showed that tourniquet application is a safe and reliable method obtaining hemostasis in hypospadias surgery. Nevertheless, further randomized studies with larger groups are required to determine the best option.

Keywords:

Hypospadias, hemostasis, Tourniquet, Adrenaline, Children,

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