title: A comparison between tourniquet application and epinephrine injection for hemostasis during hypospadias surgery: The effect on bleeding and postoperative outcome.
abstract: OBJECTIVE
  To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications.
  
  
  METHODS
  Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines. The patients' ages, urethral defect lengths, pre-operative, intraoperative and postoperative variables were compared between the two groups.
  
  
  RESULTS
  A total of 70 patients (35 in each group) were enrolled into the study. The mean ages and preoperative variables were not significantly different. Average blood loss was 23.51 ± 15.36 cc in the tourniquet group and 15.99 ± 10.00 cc in the epinephrine group, and was significantly higher in tourniquet group (P = 0.022); however, the mean operative time was not significantly different. Postoperative complications, described as Clavian classification, were reported in eight patients (23%) in the T group and 10 patients (30%) in the DE group, which was not significantly different.
  
  
  CONCLUSIONS
  Epinephrine injections minimize operative bleeding without significant harmful effects on postoperative outcomes; therefore, it could be considered to be a safe and effective method for preparation of a bloodless field during hypospadias surgery.
authors.affiliation: Kidney Transplantation Research Center, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
authors.forename: F
authors.initials: F
authors.lastname: Alizadeh
authors.affiliation: Kidney Transplantation Research Center, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Fakoor
authors.affiliation: Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address: Saeed_haghdani@yahoo.com.
authors.forename: S
authors.initials: S
authors.lastname: Haghdani
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002675:Child, Preschool; D004837:Epinephrine / Q000008:administration & dosage*; D006489:Hemostatic Techniques; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007267:Injections; D007430:Intraoperative Care; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D014111:Tourniquets; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: Epinephrine; Hemostasis; Hypospadias surgery; Tourniquet