North American Journal of Medical Sciences

COMMENTARY
Year
: 2012  |  Volume : 4  |  Issue : 7  |  Page : 323--324

Applications of cyanoacrylate glue in pediatric urology


Mirko Bertozzi, Antonino Appignani 
 S.C. di Clinica Chirurgica Pediatrica, UniversitÓ degli Studi di Perugia, Ospedale S. Maria della Misericordia, 06100 S. Andrea delle Fratte, Perugia, Italy

Correspondence Address:
Mirko Bertozzi
S.C. di Clinica Chirurgica Pediatrica, UniversitÓ degli Studi di Perugia, Ospedale S. Maria della Misericordia, 06100 S. Andrea delle Fratte, Perugia
Italy




How to cite this article:
Bertozzi M, Appignani A. Applications of cyanoacrylate glue in pediatric urology.North Am J Med Sci 2012;4:323-324


How to cite this URL:
Bertozzi M, Appignani A. Applications of cyanoacrylate glue in pediatric urology. North Am J Med Sci [serial online] 2012 [cited 2019 Dec 14 ];4:323-324
Available from: http://www.najms.org/text.asp?2012/4/7/323/98594


Full Text

Cyanoacrylates (CA) are tissue glues with a chemical structure composed by monomers that polymerize rapidly when hydrogen ions are present, creating an acrylic resin, which solidifies in <1 min. The mechanism of polymerization by contact with blood or water, creates a tight closure if applied on tissue. CA exist in two forms: Short-chain CA (methyl-2 or ethyl-2) that are rarely used, because they degrade quickly in to cyanoacrylate and formaldehyde that is very toxic for tissues; and the long-chain CA (n-butyl-2-CA and n-octyl-2- CA) that degrade slowly, thus build-up of toxic products is minimal, resulting in their being safe for topical skin closure. [1]

CA have become widely used globally since the 2004 Cochrane Database Report, [2] which stated that surgeons should consider tissue glue as an alternative to traditional suturing material as it is as effective for infection or leakage. Their use, in the form of octyl or butyl-CA, has widely increased in the past 10 years in paediatrics for closure of tension-free wounds and it has been frequently used as an alternative to conventional sutures. The principle of the use of CA is to have a tissue with a granulating process to repair the wound.

In the article "CA glue dressing for hypospadias surgery" by Mohammad Zarenezhad et al., [3] the authors used CA in several layers as alternative dressing in hypospadias surgery with good results. The glue provides a waterproof barrier from the underlying fluids (e.g. urine or blood) as well as from stools and possible infectious agents supporting a good tissue repair and preventing edema and hematoma.

The use of CA in pediatric urology is limited; the applications include repair of surgical incision, wound closure in circumcision and repair of urethrocutaneous fistula occurring after hypospadias surgery. An experimental study on rat testis, urethra and spongiosal tissue supports these clinical applications affirming that the use of CA produces a perfect healing in the urethral and spongiosal tissues while a damage to the seminiferous tubules, a decreased spermatogenesis at the operated site, a tunica albuginea irregularity and calcification of the testes were observed. [4] CA seems to be a good alternative to the conventional suturing technique in case of wound closure in circumcision with shorter operation time, ease of appliance, improved safeness, better cosmesis and significant shorter duration of postoperative pain. [5]

Another application of CA is the repair of urethrocutaneous fistula that may occur after hypospadias surgery. [6] The tensile strength of CA maintains the contact of the edges of the fistula favouring the healing process with good results in order of recovery and encouraging its use as a first non-surgical attempt for 'early' and long-standing urethrocutaneous fistulae. This treatment obtained good results in order to reduce parents' anxiety because it represents the possibility for early resolution without any surgical procedure under general anaesthesia and because the possible failure of this procedure does not compromise a possible subsequent surgical repair.

Even if clinical applications might be extended as reported in adult urology, other clinical and experimental studies will be necessary to give new indications to this kind of sealant in pediatric urology.

References

1Sinha S, Naik M, Wright V, Timmons J, Campbell AC. A single blind, prospective, randomized trial comparing n-butyl 2-cyanoacrylate tissue adhesive (Indermil) and sutures for skin closure in hand surgery. J Hand Surg Br 2001;26:264-5.
2Coulthard P, Worthington H, Esposito M, Elst M, Waes OJ. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2004;(2):CD004287.
3Zarenezhad M, Hosseini SM. Cyanoacrylate glue dressing for hypospadias surgery. North Am J Med Sci 2012;4:320-2.
4Ayyildiz A, Nuhoðlu B, Cebeci O, Caydere M, Ustün H, Germiyanoðlu C. The effect of cyanoacrylic glue on rat testis, urethra and spongiosal tissue: An experimental study. J Urol. 2006;175:1943-7.
5Elemen L, Seyidov TH, Tugay M. The advantages of cyanoacrylate wound closure in circumcision. Pediatr Surg Int 2011;27:879-83.
6Prestipino M, Bertozzi M, Nardi N, Appignani A. Outpatient department repair of urethrocutaneous fistulae using n-butyl-cyanoacrylate (NBCA): A single-centre experience. BJU Int 2011;108:1514-7.