Hypospadias Clinical Trial
Official title:
The Effect of Amniotic Membranes on Complex Genitourinary Reconstruction Outcomes in Pediatric and Adult Populations
Urinary fistulas are unfortunately one of the most common post operative complications in hypospadias repairs and bladder neck transections on pediatric and adult populations, an estimated 20%, resulting in multiple repeat operations with prolonged hospitalization. The negative sequelae of these fistulas have significant financial and psychosocial impact and the aim of this study is to evaluate if the fresh frozen preserved amniotic membrane tissue studied, which have live cells and intact naturally occurring growth hormones and peptides that augment healing that have been shown in early studies to be effective facilitating previous failed fistula repairs and leg ulcer healing, respectively, will help reduce the incidence of urinary fistulas in subject populations.
Urinary fistulas in the pediatric and adult populations present significant surgical and
economical challenges. These include urethrocutaneous and vesicocutaneous fistulas, which are
unfortunately common in the investigators' patients with hypospadias and bladder exstrophy,
respectively. Urethrocutaneous fistula is the most common complication following surgical
repair of hypospadias with an incidence of 4-25%. This high complication rate is especially
problematic as these fistulas once formed often recur requiring multiple surgical repairs
resulting in potentially harmful physical and psychologic consequences on young patients.
Vesicocutaneous fistulas develop in bladder exstrophy patients at a estimated rate of 20%
following surgery aimed at making these patients continent by transecting the bladder neck
and creating a catheterizable channel. Small, simple fistulas can be repaired primarily,
however larger, multiple or recurrent fistulas must be closed in layers. Layered closures
have been found to have higher success rates have been demonstrated with using additional
tissue layers refistulization rate including local and distant tissue grafts, which add time
and morbidity to surgical repairs.
Amniotic membranes have been shown to increase healing in chronic wounds such as a chronic
venous stasis and diabetic ulcers and have been used in fistula repairs. Grafix and Stravix
are frozen preserved placental membranes and Wharton's Jelly, respectively, that have high
quantities of viable mesenchymal stem cells (MSCs), which add in tissue healing. The
investigators believe these membranes can be used as a structural layer in fistula repairs,
hypospadias repairs, and bladder neck closures to treat existing fistulas and prevent fistula
formation in the primary repair setting.
1. This is a prospective study examining patients with hypospadias will be considered for
repair with the use of amniotic membranes. The repair of fistula with graft tissue is
standard of care.
2. Eligible patients will be identified in a clinic visit with one of the co-investigators.
a. The patient will be consented and undergo a repair using amniotic membranes within
the fistula site or primary repair at the discretion of the operating surgeon. Using
different repair techniques is standard of care, however, the use of frozen preserved
placental membranes is the study material. The size of the product will be determined by
the surgical need at the time of repair.
3. The patient will be discharged be provided with routine postoperative care and seen in
approximately 2 weeks per standard of are.
4. If the participant fails repair of participant's fistula, participant will not be
offered a repeat repair with the amniotic membranes. Other forms of surgery may be
offered, however.
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