BUCCAL MUCOSA GRAFT AND LOCAL TISSUE FLAP IN COMPLEX HYPOSPADIAS REPAIR: ONE STAGE VERSUS TWO STAGES

Abstract

Introduction: Urethral reconstruction in complex hypospadias (either severe primary or crippled)
poses a significant challenge. We report our experience using buccal mucosa onlay grafting with local
tissue flap (tunica vaginalis or dartos) as a second layer coverage of the neourethra to repair complex
hypospadias in one stage Vs two stages.
Materials and Methods: We prospectively evaluate 32 patients with complex hypospadias who
underwent ventral onlay buccal mucosa graft urethroplasty with local tissue flap (tunica vaginalis or
subcutaneous dartos flap) as a second layer coverage of the new urethra in Zagazige university
hospitals in-between August 2008 and April 2011. Repair done in one stage for 20 pts (group one) (8
primary, 6 crippled, 6 fistulae) and in two stages for 12 pts (group two) (8 primary, 4 crippled). Tunica
vaginalis flap used in 18 cases and subcutaneous dartos flap which used in 14 cases. Follow up ranged
from 6 to 30 months. Early and late Complications reported, analyzed and compared between both
groups. Minor and major complications managed conservatively and those failed need reoperation.
Reoperation rates in both groups used as the failure rate.
Results: early complications(Edema, Bleeding & hematoma, Infection, Catheter problems, Glans
dehiscence, Wound dehiscence, Fistula and graft loss) were 19 in 6 patients in group one and 11 in 4
patients in group two. Late complications (meatal stenosis, urethral stricture, graft contracture and
residual chordee) were 7 in 4 patients in group one and 6 in 3 patients in group two. The overall
Reoperation was 9/32 ( 28.125%), 6 patients (30%) in group one and in group two needed only for 3
patients (25%) for fistula closure, meatoplasty, orthoplasty and VIU. No donor site complications
reported.
Conclusions: Buccal mucosa appears to be a durable source of nongenital tissue for urethral
replacement. Onlay buccal mucosa urethroplasty for complex hypospadias repair is of good results
obtained with both in one stage or two stage repair with better results in two stage approach.