Efficacy of one–stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

Abstract

Objective To evaluate the outcomes of patients who underwent one–stage onlay or inlay urethroplasty using lingual mucosal grafts (LMG) to treat male patients with less available skin after a failed attempt at hypospadias repair. Methods We retrospective analyze the clinical material of 68 patients with failed hypospadias repairs were treated in our hospital between Jan. 2008 and Dec. 2013, The median age was 22 (4–45) years. The median prior unsuccessful repairs was 1.9 (1–6) times. Inclusion criteria were a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of another graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair with a reoperative urethroplasty using the foreskin or a multistage repair urethroplasty. Two techniques of urethroplasty were performed according to the patients with or not penile curvature during the erection. One–stage onlay LMG urethroplasty was performed in 52 patients and a modified Snodgrass technique using one–stage inlay LMG urethroplasty was performed in 16. The median LMG urethroplasty length was 5.6 (4–13) cm. Results The median follow–up was 39 (5–70) mon, 54 patients voided well with urinary peak flow rates were median 24.5 (14.0 to 46.0) ml/s and complications developed in 14 patients (21.6%), including urethrocutaneous fistulas in 8 patients and neourethral strictures in 6 patients (meatal stenosis in 3 cases, proximal anastomotic site stricture in 3 cases). 8 patients with urethrocutaneous fistulas were repaired with salvage procedure, succeed in 4 and another 4 patients await further reoperation. Three patients with meatal stenosis were corrected by meatoplasty and 3 patients with proximal anastomotic site stenosis were only treated by dilatation for 4 and 6 months respectively, after that the patients voided well. Conclusions One stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs. Key words: Hypospadias; Failed; Urethroplasty; Lingual mucosa