M.L. Djordevic M. Majstorovic D. Stanojevic One-stage repair of severe hypospadias using combined buccal mucosa graft and longitudinal dorsal skin flap Eur J Pediatr Surg 18/6 2008 (December) 427 430

Abstract

Urethral reconstruction in severe hypospadias presents a great challenge. The authors evaluated a method combining longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in the most severe hypospadias in a 1-stage procedure. Twenty-three patients underwent repair of severe hypospadias, aged 9 to 26 months (18 penoscrotal and 5 scrotal). The short urethral plate was divided in all cases and the remaining curvature was repaired by dorsal incision. The buccal mucosa graft was harvested and fixed to the ventral side of the cavernous corpora to form the first half of the neourethra. A longitudinal dorsal island skin flap was created and ventrally buttonholed. It was sutured to the buccal mucosa graft to form the neourethra. An abundant flap pedicle was fixed laterally to cover all sutures of the neourethra. Penile skin reconstruction was done using available penile skin. Mean follow-up was 27 months (11-66 months). Satisfactory results were achieved in 20 patients. There were 2 urethral fistulas and 1 temporally distal urethral stricture. It is concluded that a combined longitudinal island skin flap and buccal mucosa graft can be a goad choice for single-stage urethral reconstruction in the repair of most severe hypospadias.