Assessment of the value of platelet rich fibrin (PRF) in the treatment of recurrent hypospadias cases in children: a comparative study

Although current techniques for hypospadias repair are associated with minimal complications, some patients still require secondary procedures due to unsuccessful outcomes. So, this study aimed to assess the value of using platelet rich fibrin as a covering layer in recurrent hypospadias repair; including cases of complete failure or urethro-cutaneous fistula. This prospective study was conducted on 80 patients presenting with recurrent hypospadias, including cases of complete disruption and urethrocutaneous fistula. All patients were referred to the Pediatric Surgery Unit at Cairo University Specialized Pediatric Hospital between July 2019 and January 2023. The study cohort was randomized into two equal groups (A and B). Patients in Group A (non-platelet group) underwent repair using a dartos flap alone as the covering layer, whereas those in Group B (platelet group) received an autologous platelet-rich fibrin (PRF) membrane followed by coverage with a dartos flap. The mean operative duration was significantly longer in the PRF group compared with the non-PRF group in UCF cases (P = 0.013), with a mean difference of approximately 8 min. The primary outcome, recurrence (defined as postoperative urethrocutaneous fistula or complete failure), was observed in 17 of 80 patients (21.25%). Recurrence occurred in 11 patients (27.5%) in the non-PRF group and in 6 patients (15%) in the PRF group. Accordingly, the success rate was higher in the PRF group (85%) than in the non-PRF group (72.5%); however, this difference did not reach statistical significance (P = 0.137). Postoperative mild edema and inflammation were significantly more frequent in the PRF group than in the non-PRF group (P = 0.03). No significant differences were observed between the two groups regarding baseline characteristics, surgical techniques, postoperative meatal stenosis, severe infection, hemorrhage, or cosmetic outcomes. Platelet-rich fibrin (PRF) sheets represent a safe, cost-effective, and easily prepared autologous material and promising adjunct that may enhance healing, but further large-scale studies are needed to prove superiority. Although a minor increase in operative duration was observed, approximately 8 min, it was clinically insignificant and did not impose any additional anesthetic or surgical risk, particularly when weighed against the potential benefits in reducing postoperative recurrence. The results of the current study further support the practicality and reliability of using a PRF sheet as an intermediate layer in hypospadias reconstruction. This approach appears particularly advantageous in recurrent cases, where local tissue coverage options are often limited.