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THE APPLICATION OF TOPICAL EXTRACT OF ALLIUM CEPAE, ALLANTOIN AND
HEPARIN GEL IMPROVES THE GRAFT SITE IN BRACKA'S METHOD OF PROXIMAL
HYPOSPADIAS
Can TANELI
1
, Omer YILMAZ
1
, Aynur GULTEKIN UYANIK
1
, Canset KARADAG YIGIT
1
, Gonul DINC HORASAN
2
and
Abdulkadir GENC
1
1) Celal Bayar University, Faculty of Medicine, Department of Pediatric Surgery Division of Pediatric Urology, Manisa,
TURKEY - 2) Celal Bayar University, Faculty of Medicine, Department of Biostatistics, Manisa, TURKEY
PURPOSE
The aim of the present study is to evaluate the efficiency of application of topical extract of allium cepae, allantoin and
heparin gel use at the graft site at two staged Bracka's method in proximal hypospadias.
MATERIAL AND METHODS
Between 2012-2014, 20 patients were operated with two-staged Bracka's procedure. In this prospective randomized
study, in the first stage of the operation, urethral plate was excised and preputial free graft was applied. In the
treatment group (n=14) patients were advised to apply the topical scar gel (Contractubex®) once daily and the control
group (n=6) received no treatment. In the treatment group, topical gel was applied between postoperative 2nd -5th
months. The ventral penile graft was evaluated by validated Patient and Observer Scar Assessment Scale(POSAS)
during the second stage urethroplasty by thickness, irregularity and pliability criteria. POSAS is evaluated as normal skin
(min=1), bad scar (max=10). Results are given as median (25-75 quartile) values. Statistical analysis was performed
by Mann Whitney-U test.
RESULTS
In all cases of the control group, scalpel hole area scars were evident. Additionally in 2 cases quilting stich areas are
observed irregular. In the treatment group no scar formation was seen at the scalpel hole area; the graft thickness,
irregularity and pliability was improved. POSAS thickness (2.00 (1.00-3.00) vs 4.00 (3.00-4.25) (p=0,001); irregularity
(2.00 (1.00-2.00) vs 3.00 (3.00-4.00) (p=0.002); pliability (2.00 (1.00-3.00) vs 4.00 (3.75-4.25) (p=0.001) and
overall scores (2.00 (1.00-3.00) vs 4.00 (3.75-4.00) (p=0.001) in the treatment and control groups, respectively.
CONCLUSIONS
Topical gel containing extract of allium cepae , allantoin and heparin application lead to statistically significant
improvement in thickness, irregularity and pliability scores of the graft tissue. Thus, gel application results in more
convenient graft tissue leading to surgical comfort at the second stage urethroplasty in proximal hypospadias.