Abstract

1.1.Introduction: Urethral reconstruction in complex hypospadias (severe primary or crippled) poses a significant challenge. We report our experience with ventral onlay buccal mucosa graft in complex hypospadias repair.

1.2.Materials and methods: 32 patients with complex hypospadias (16 severe primary and 16 crippled) 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. Tunica vaginalis flap used in 18 cases and subcutaneous dartos flap used in 14 cases. BMG harvested in all cases from inner check by the technique described by Eppley et al. [1]. Follow up ranged from 6 to 30 months. Early and late Complications reported. Success defined as patient has a straight penis with meatus at the tip of the glans without functional complications need reoperation procedures.

1.3.Results: 29 early complications (edema, bleeding & hematoma, infection, catheter problems, glans dehiscence, wound dehiscence, fistula and graft loss) occurred in10 patients (31,25%). 13 Late complications (meatal stenosis, urethral stricture, graft contracture and residual chordee) in 7 patients (21,875%). Conservative management succeeds to decrease the number of patients those need reoperation procedures to 9/32 (28.125%), for fistula closure, meatoplasty, orthoplasty and VIU. No donor site complications reported.

1.4.Conclusion:Buccal mucosa appears to be a durable source of non genital 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 stages approach.

Keywords

Ventral onlay buccal mucosa graft, Complex hypospadias repair, Urethral reconstruction, Tunica vaginalis flap, subcutaneous dartos flap, Edema, Bleeding, Hematoma, Catheter problems, Meatoplasty, Orthoplasty