A Novel Urological Application of Hyaluronic Acid/Alginate Sheet to Prevent Adhesion Formation: A Technique Guide and Case Series

Abstract

Tissue gliding and mobility are paramount to the success of penile procedures. While postoperative healing is intended to protect, repair, and nourish injured tissues, an overzealous response often leaves painful and debilitating tethering between the corpora, including nerves, and surrounding tissues. This tethering interferes with the intended outcomes of surgery by preventing necessary gliding. An ideal implant that serves as a tissue gliding companion would be an easy-to-apply, temporary gliding surface that prevents unwanted tethering, bioresorbs completely, and flexibly addresses tissues that significantly contract postoperatively. Unfortunately, most commercially available options are difficult to use intra-operatively, are not designed to reduce friction, have variable efficacy, and have incomplete bioresorption. A promising new technology is a hydrogel made from alginate and hyaluronic acid (HA). Application of this hydrogel is revolutionizing orthopedic hand surgery, spine surgery, sports injury repair, and foot and ankle surgery with placement of gel/sheets around a range of soft tissue environments (joints, tendons, ligaments, peripheral nerves, vasculature) without issue. We present a case series of four patients undergoing various urologic procedures with the application of this novel bioresorbable hydrogel and their associated excellent clinical outcomes with no adverse events. We also discuss potential urologic indications for the use of this bioresorbable hydrogel along with technical intra-operative considerations.