Buccal Mucosal Graft for Crippled Hypospadias (Experience in 11 Cases)

Abstract

Background: Hypospadias is defined as the incomplete virilization of the genital tubercle causing an incomplete development of the tissues forming the ventral urethra.
Objective: Free buccal mucosal graft is an excellent option if the genital tissue is fibrous or deficient. We would like to present our small experience with buccal mucosa on-lay graft for the treatment of anterior urethral stricture and recurrent urethra-cutaneous fistula after hypospadias
repair in male children.
Methods: Between October 2004 and March 2007 we operated upon nine male patients. Their age ranged from 3-12 years old. Free buccal mucosal on-lay grafts from the inner aspect of the lower lip were taken for three cases of complicated anterior urethral stricture and for six cases of recurrent urethra-cutaneous fistula after previous multiple penile hypospadias repairs. Nine on-lay free grafts were ventrally placed on the penile urethra. The grafts length ranged from 0.5 to 6 centimeters. All these operations were performed in one stage by a single surgeon and his
team. The follow up period was from 2 to 5 years.
Results: The success was achieved in 8 out of 11(73%) patients. Urethral complications occurred in three cases which were evident by one month and three months postoperatively. The first one had severe proximal and distal urethral strictures which eventually required a proximal urethrostomy as
a first stage. The second one had a mild stenosis which required two meatal dilitations and at last a meatoplasty. The third one had a small fistula which was simply closed later. One patient developed a hypertrophied scar at the harvest site which spontaneously resolved over a period of three months.
Conclusion: Complex hypospadias surgery is challenging and should be done by an experienced pediatric surgeon. Utilizing the buccal mucosa in case of deficient genital skin is an efficient, practical, and safe technique of managing the crippled cases that need redo surgery.

Key words: Hypospadias, buccal, on-lay graft.