Hypospadias surgery is often associated with unfavorable outcomes, such as fistula formation and tissue contracture. While various procedures exist for hypospadias repair, complication rates range from 4% to 27%, depending on the approach. Re-operations for complex cases after failed repairs pose even greater challenges for urologists, with an even higher risk of complications. Hyperbaric oxygen therapy (HBOT) is widely recognized for its role in promoting tissue healing in chronic wounds. This study aims to evaluate the utility and safety of HBOT in patients undergoing hypospadias treatment.

Systematic research was conducted in PubMed using the keywords “hyperbaric oxygen therapy” and “hypospadias.” The primary outcomes included the incidence of complications and graft failure, while the secondary outcomes included the side effects of HBOT.

Four non-randomized original studies were identified as relevant to our topic. These studies mainly explored the application of HBOT in complex, re-operative hypospadias cases. The standard HBOT protocol included 10 sessions starting on postoperative day 1, with 100% oxygen exposure at 2–2.4 atm for 90–130 minutes per session. Furthermore, Bush et al. implemented a protocol of 20 HBOT sessions before conducting tubularized autograft repair using oral mucosa. All four studies demonstrated that HBOT significantly reduced complication rates following hypospadias surgery, particularly by decreasing graft contracture and graft failure rates. Although claustrophobia was noted as a possible concern during HBOT, no significant side effects were reported in any of the studies.

HBOT is a safe therapeutic option for patients and can be considered as an adjuvant or rescue approach for those undergoing re-do hypospadias repair. Furthermore, its potential to serve as a preemptive strategy in managing complex cases should be explored. However, larger sample sizes and prospectively randomized studies are needed to further validate its effectiveness.