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One Stage Urethroplasty in Severe Hypospadias Using Buccal Mucosa and Longitudinal Penile Island Flap

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      Purpose

      The incorporation of the urethral plate into the neourethra is essential for a successful correction of Hypospadias. However, the quality and availability of the urethral plate is variable in severe forms of Hypospadias, thus it is often difficult to repair these using conventional methods. We present a single stage method of combining buccal mucosa and longitudinal onlay island penile flap for urethral reconstruction.

      Material and Methods

      During the period from October 2003 to June 2009, a total of 14 children with the mean age of 18 months (range 6-26 months) underwent this type of surgery. The indication was scrotal Hypospadias (n=8), perineal Hypospadias (n=4) and Hypospadias without Hypospadias (n=2). In all cases the urethral plate was too short and had to be divided. The penis is completely straightened using the Yachia technique. Longitudinal penile island flap was harvested with abundant and redundant vascularized subcutaneous tissue from dorsal penile and preputial skin. Buccal mucosa was grafted on the tunica albuginea in-between the divided parts of the urethral plate. Longitudinal vascularized skin flap was button-holed ventrally. The edges of the flap and buccal mucosa were sutured together in an onlay manner, to form the neourethra. Glans wings were reunited over the neourethra. The remaining penile skin was used to cover the penile body.

      Results

      The follow up was 2.8 years (range 3 months to 4,5 years). Good esthetic and functional results are achieved. The patients void easily through their neourethra. No fistulas or stenosis occurred. One Two children have a urethral diverticula.

      Conclusions

      Urethroplasty using buccal mucosa graft and vascularized penile skin flap represent a good choice in cases where the urethral plate is short, absent or of bad quality. The procedure has the advantage of an onlay procedure performed in a single stage.
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