Dorsal Onlay Oral Mucosa (DOOM) urethroplasty for post-hypospadias stricture.

INTRODUCTION

We report our experience with Dorsal Onlay Oral Mucosa (DOOM) urethroplasty in the management of hypospadias strictures.

METHODS/TECHNIQUE: After anesthesia, via midline penososcrotal incision urethra was mobilized/rotated to expose 12 O'clock where stricturotomy was performed. Oral mucosa was harvested from the lower lip, defatted, and tailored to the stricture length. The graft was sutured dorsally as onlay using 6-0 PDS sutures (video). Catheter was kept for 14 days and SPC was removed after successful voiding. A retrospective analysis was conducted between 2010 and 2020. Objective and subjective measures included peak urinary flow rate (Qmax), and parental penile perception score (PPPS).

RESULTS

A total of 22 patients were analyzed; median age 12 (9-15) years; mean stricture length 2.5 cm, median follow up 6 (4-14) years. Postoperatively, mean Qmax improved from 3.1 to 10.2 mL/s (p < 0.05). Donor-site morbidity (mild discomfort and transient tightness) resolved spontaneously. Stricture recurrence occurred in 1/22 (4.5 %) of patients; treated with OIU. None developed fistula, diverticulum, or significant stricture warranting a repeat procedure. Excellent parental penile perception score (95 %) was noted.

CONCLUSION

DOOM Urethroplasty is a safe, effective, and reproducible technique for reconstructing post-hypospadias urethral strictures. Further larger studies are warranted.