Treatment of complex hypospadias repair failures

Abstract

Objective To investigate the result of applying free mucosa grafts or foreskin flaps to treat repair failed hypospadias. Methods Thirty-six patients with repair failed complex hypospa- dias were treated by foreskin flaps or free mucosal grafts urethroplasty.Of the 36 patients,foreskin flap urethroplasties were performed in 7 patients,buccal mucosal graft urethroplasties in 7.1ingual mucosal graft(LMG)urethroplasty in 9,colonic mucosal graft urethroplasty in 2 cases.combined LMG and foreskin flap urethroplasties in 3 patients,Two oral mucosal grafts urethroplasties in 8 pa- tients.The penis was wrapped with soft,elastic,and roller bandage incorporating the traction suture into the dressing for four days and antibiotic liquid was injected into urethra every day. Results Pa- tients were followed up for 3-84 months(mean 32.6 months)postoperatively. Urethrocutaneous fis- tulas developed in 4 patients between 2 and 3 weeks postoperatively and urethral strictures developed in 3 patients at 2-4 months postoperatively.Of the 3 patients.anastomotic stenosis developed in 1 patient who underwent 5 urethral dilations and the patient could void well after that.Meatal stenosis developed in 2 patients who needed re-operation and the patients could void well with a peak urinary flow rates of 37.3 and 28.7 ml／s respectively after the re-operation.The other patients voided well and the peak urinary flow rates ranged from 18.0-46.0 ml／s. Conclusions The treatment of repair failed hypospadias is a tough problem in urological surgery.Lingual mueosa and buccal mucosa onlay grafts substitution urethroplasty has advantages of easy to harvest,a little trauma to patient and is a good urethral substitution technique for less skin available in patients of repair failed hypospadias. Key words: Mucous membrane; Surgical flaps; Hypospadias; Urethroplasty