Impact of Various Hemostasis Techniques on Histological and Biochemical Changes during Hypospadias Surgery

The choice of hemostasis technique during hypospadias surgery plays an important role in the surgical outcome. However, the literature lacks studies on optimal hemostatic techniques and studies to compare the histological and biochemical effects of different hemostatic methods.

The objective of this study was to evaluate the cellular and biochemical changes in the penile tissue when different hemostasis techniques are applied.

A prospective study was conducted over 12 months, including 42 patients undergoing urethroplasty for hypospadias. Patients were categorized into three groups based on hemostasis technique: tourniquet only (Group A), epinephrine only (Group B), and both tourniquet and epinephrine (Group C). Histopathological changes and tissue malondialdehyde (MDA) levels, a marker for tissue oxidative stress, were assessed in preputial skin and dartos layer.

Histological changes, including inflammation, capillary proliferation, and hemorrhage in the skin and dartos layer, were seen in higher numbers when a tourniquet was applied, but was not statistically significant. MDA level was raised across all the groups following hemostasis (2.71 µM/l to 8.93 µM/l in skin and 1.67 µM/l to 6.73 µM/l in dartos layer) but was significantly raised when the tourniquet was applied with or without epinephrine (P < 0.05 and P = 0.0001), indicating significant histological and biochemical changes with tourniquet.

The tourniquet application has shown pronounced biochemical changes at the cellular level, making epinephrine application as a safer alternative. Our study emphasizes the importance of judicious selection of hemostasis techniques during hypospadias surgery.