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Preoperative preparation with erythropoietin for hypospadias surgery

M. Renaux-Petel, M. Beurdeley, D. Comte, A. Liard-Zmuda

Pediatric Surgery Department, Charles Nicolle Hospital, Rouen, France



Objective: To research the effects of preparation with erythropoietin(EPO) in children operated for hypospadias on peroperative bleeding and on the cicatrization.

Material and methods: 22 patients were operated for hypospadias using the Onlay technique between January 2001 and September 2008 and had erythropoietin preparation started 3 weeks before surgery. All children had an oral preparation during the 2 months preceding the intervention. They received between 3 and 5 injections of EPO depending on the hematocrit. 7 presented a middle hypospadias, 2 a posterior penile hypospadias and 12 a penoscrotal hypospadias. The average age at the time of surgery was 13.5 months (10 – 22 months), and the children weighed an average 9.2 kg (7 -12 kg). All were operated using the Onlay technique, associated in 14 cases `with Nesbitt, in 3 cases with scrotoplasty, in 4 cases with cure of an ectopy, in 1 case with cure of an inguinal hernia. All children were reviewed at 4 months.

Results: The average preoperative hematocrit was 41%, meaning a gain of 3.8 points average (-4 to +11 points). The peroperative loss of hematocrit was evaluated at 6.6 points (-1 to -11 points). At the end of the surgery, 12 children had a hematocrit inferior to 35%, 4 among them inferior to 30%. None required transfusions. 4 months after surgery 18 children had an apical meatus (85.7%). 3 presented with a balano-preputial meatus, 1 among them had to be reoperated using the Duplay technique. 2 children had meatal stenosis, 1 benefited from reintervention for meatostomy. No fistulas and no flap necrosis were observed.

Conclusion: Erythropoietin preparation of severe hypospadias cases operated using the Onlay technique seems to offer a number of advantages: on one hand a more elevated hematocrit at the end of surgery than after preparation with iron alone, on the other hand a smaller rate of postoperative complications, especially fistulas and flap necrosis.


Key words: erythropoietin, hypospadias surgery, Onlay technique