Impact of Tranexamic Acid for Hemostasis on Postoperative Complications in Pediatric Hypospadias: A Prospective Controlled Study

Abstract

Objective: This study aims to investigate the effects of intravenous tranexamic acid (TXA) hemostasis during pediatric hypospadias surgery on postoperative complications. Materials and methods: A prospective randomized controlled study was conducted involving patients undergoing transverse preputial island flap urethroplasty (Duckett procedure) for hypospadias between January 2021 and February 2023, who were divided into the TXA group and the control group. Clinical parameters between the two groups were compared, and single-factor and logistic regression analyses were conducted to determine the impact of TXA application on postoperative complications in hypospadias surgery. Results: A total of 124 hypospadias patients were followed up, with 64 in the TXA group and 60 in the control group. In the TXA group, intraoperative blood loss, electrotome usage, pre- to postoperative change in hemoglobin (ΔHB), and change in hematocrit were significantly lower compared to the control group (p＜0.05). Single-factor analysis of postoperative complications showed significant correlations with urethral defect length, electrotome usage, intraoperative blood loss, ΔHB, and bleeding complications after removing the penile bandage (p＜0.05). Multivariate logistic regression analysis indicated that TXA application (p=0.049), electrotome usage (p=0.003), intraoperative blood loss (p＜0.001), and ΔHB (p=0.001) were independent predictors of postoperative complications. Conclusion: Intraoperative blood loss and pre- to postoperative change in hemoglobin are independent predictors of complications in the Duckett procedure for hypospadias surgery. Moreover, TXA can reduce blood loss and lower the risk of postoperative complications in patients undergoing the Duckett procedure.