Can a platelet-rich plasma covering layer reduce urethrocutaneous fistula rate after distal penile hypospadias repair using the STAR (Seleim’s topography-guided anatomical reassembly) technique? A randomized controlled trial

Abstract Objective To evaluate the benefit of using platelet-rich plasma (PRP) covering layer in decreasing urethrocutaneous fistula rate post-distal penile hypospadias repair using the STAR technique. Methods This prospective randomized controlled trial included 44 boys with primary distal penile hypospadias. Patients were randomized into two groups: Group A ( n = 22) underwent repair using the STAR technique with an additional PRP layer over the neourethra, while Group B ( n = 22) received the STAR repair without PRP. PRP was prepared from autologous blood and applied as an intermediate layer before skin closure. Patients were followed for at least 4 weeks. The primary outcome was the incidence of urethrocutaneous fistula (UCF). Secondary outcomes included postoperative complications (edema, infection, meatal stenosis), operative time, and cosmetic outcome using the Hypospadias Objective Scoring Evaluation (HOSE). Results The two groups (22 patients per group) were similar in age (median ~ 20 months in each, p = 0.96) and other preoperative characteristics. The incidence of urethrocutaneous fistula was significantly lower in the PRP group (4.5% [1/22]) compared to the non-PRP group (27.3% [6/22], p = 0.039). Other postoperative complication rates showed no statistically significant differences: edema occurred in 4.5% of Group A vs 0% of Group B ( p = 1.00), meatal stenosis in 4.5% vs 0% ( p = 1.00), and no wound infections occurred in either group. Mean operative time was slightly longer with PRP (70.2 ± 16.5 min vs 61.1 ± 15.7 min without PRP) but did not reach statistical significance ( p = 0.068). Conclusion Incorporating PRP as a biological layer in distal hypospadias repair using the STAR technique significantly reduced urethrocutaneous fistula rates without increasing complications. PRP is a safe autologous adjunct that may improve surgical outcomes.