V40 - Penis and glans reconstruction with buccal mucosa graft in a multi-operated, failed hypospadias repair

Abstract

Introduction & Objectives: Hypospadias surgery represents a complex field within the domain of the reconstructive urologist. 1 Today, it is known 2 failed hypospadias repair comprises an even more challenging problem that requires the mastering of multiple different techniques in order to that more severe grades of hypospadias are associated with a higher failure rate after primary intervention. Therefore, restoration of a penis after 3 using buccal mucosa grafts in patients with failed hypospadias repair. This video demonstrates the different steps of our technique. Materials & Methods: A 21-year-old male patient who has previously undergone over 40 failed surgeries to correct for penoscrotal hypospadias was referred to our department for penis and glans restoration. His past surgical history included 41 failed hypospadias surgeries elsewhere. As the patient is able to have sexual intercourse with residual sensate glans tissue, a complete phallic reconstruction was not considered. Furthermore, we created a retrospective database of all patients who underwent penis and glans reconstruction after multiple failed attempts of hypospadias repair. Results: A prepubic Z-plasty is performed to allow dorsal lengthening of the penile shaft. The remaining glans tissue is circumcised to retain maximal genital sensitivity. Scar tissue surrounding the penile shaft is removed, the suspensory ligament is incised and the cavernosal bodies are dissected to further gain penile length. All prepubic and penoscrotal subcutaneous fibrosis in the is resected to gain skin elasticity. The proximal penile shaft is covered with skin while the most distal aspect is covered with two buccal mucosa grafts of each 6 x 2.5cm to reconstruct an aesthetic glans. Between November 2014 and June 2020, 6 adult patients underwent reconstruction with buccal graft mucosa. All patients had undergone multiple (>15) surgeries before being referred to our centre. The initial condition was hypospadias in 1 patient, partial penile amputation for carcinoma in 3 patients, and glans amputation after circumcision accident in 2 patients. More information about previous surgeries could not be retrieved. All patients were pleased with the aesthetic result and reported satisfying sexual functioning at six months after surgery. Conclusions: Penile and glans restoration after failed hypospadias surgery remains a great challenge to the reconstructive surgeon. Buccal mucosa grafts have an established function in urethral repair. They also form a valid option for glans reconstruction in failed hypospadias patients.