Laser tissue soldering for hypospadias repair: Results of a controlled prospective clinical trial

Purpose: Laser tissue soldering has been shown to provide safe and effectiv e tissue closure by creating an immediate leak-free anastomosis with minima l scar formation. We compared the results of laser tissue soldering and con ventional suturing for hyposadias repair. Materials and Methods: A consecutive group of 138 boys 4 months to 8 years old (mean age 15 months) was divided into a standard suturing (84) and a su tureless laser (54) hypospadias repair group. Urethral repair was defined a s simple (Thiersch-Duplay or Snodgrass) and complex (onlay island flap or t ube) in 101 and 37 cases, respectively. Laser tissue soldering was performe d with 50% human albumin solder doped with 2.5 mg/ml. indocyanine green dye using an 808 nm. diode laser at 0.5 W. In the laser group sutures were use d for tissue alignment only. At surgery neourethral and penile length, oper ative time for neourethral construction and the number of sutures or throws were measured. Postoperatively patients were examined for complications of wound healing, stricture or fistula. Results: Mean patient age, urethral defect severity, type of repair, neoure thral length and stenting time plus or minus standard error of mean were no t significantly different in the 2 groups. Mean operative time was a fifth as long for laser tissue soldering in simple and complex hypospadias repair compared to controls (1.5 +/- 0.1 and 5.1 +/- 0.3 versus 8.5 +/- 0.8 and 2 6.7 +/- 1.7 minutes, respectively, p <0.001). The mean number of sutures us ed for tissue alignment in the laser group for simple and complex repair wa s significantly less than in controls (3.0 +/- 0.2 and 8.2 +/- 0.6 versus 8 .5 +/- 0.8 and 23.2 +/- 1.5, respectively, p <0.001). All patients were fol lowed a mean of 12 months (minimum 6, maximum 22). The complication rate wa s 4.7% in the laser group and 10.7% in controls with fistula in 2 of 54 cas es, and fistula and meatal stenosis in 7 and 2 of 84, respectively. Conclusions: These preliminary results indicate that laser tissue soldering for hypospadias repair may be performed in almost sutureless fashion and m ore rapidly than conventional suturing. The ease of the laser technique and the lower complication rate in the laser group indicate that laser tissue soldering is an acceptable means of tissue closure in hypospadias repair.