The effect of hyperbaric oxygen therapy on hypospadias reconstruction: A preliminary randomized controlled trial study of VEGF levels and HOPE score analysis

Introduction: Hypospadias is a congenital abnormality of the urethral meatus in males. Hypospadias can be corrected by two-stage urethroplasty. Hyperbaric oxygen therapy (HBOT) can accelerate wound healing after surgery by increasing oxygenation, angiogenesis, and collagen synthesis. This study aimed to measure the effectivity of HBOT based on serum vascular endothelial growth factor (VEGF) level and Hypospadias Objective Penile Evaluation (HOPE) score in hypospadias reconstruction patients. Methods: This was a randomized controlled trial study. Hypospadias reconstruction was performed using the Sidik-Chaula and Manset Flap techniques. Each HBOT session ranged from 30-60 minutes, administered at 1-3 atm. Twenty subjects were divided into two groups: the HBOT and control groups. VEGF serum levels were measured 1 hour after the operation and 1 hour after every HBOT session. The HOPE score was assessed at the bedside by the attending physician, consisting of six items: the position of the meatus, the shape of the meatus, the shape of the glans, the shape of the penile skin, and the shape of the penile axis, including penile torsion and penile curvature. The data were analyzed with SPSS version 28, using the Shapiro-Wilk and independent t-test methods. Results: There was a trend of increasing VEGF levels as the number of HBOT sessions increased, with significant increase found in patients who underwent three (p = 0.038), four (p = 0.002), and five (p = 0.008) HBOT sessions. We found a significant increase in the total HOPE score (p = 0.028) and penile torsion score (p = 0.006) in the HBOT group. Conclusions: HBOT can accelerate wound healing after urethroplasty. Three or more HBOT sessions are recommended after the repair of hypospadias.