[Combined buccal mucosal graft and scrotal flap for reconstruction of urethra in primary hypospadias repair].

OBJECTIVE

To investigate a method of repairing hypospadias by combining buccal mucosal graft with scrotal flap and its therapeutic effect.

METHODS

From March 2002 to December 2007, 42 patients with hypospadias underwent primary urethral reconstruction using buccal mucosal graft and scrotal flap. The patients ranged in age from 18 months to 18 years. There were 21 cases of penoscrotal type, 12 cases of scrotal type and 9 cases of perineal type. Among them, 8 cases were at initial operation, and 34 cases suffered from'the failure of hypospadias repair 6-19 months (average 10 months) after initial operation. During operation, the defect of urethra was 3-7 cm (average 4.2 cm) when the penis was straightened; the buccal mucosa (3.0 cm x 1.2 cm-7.0 cm x 1.5 cm) was transplanted to the tunica albuginea in the ventral aspect of the penis, and was paired with the scrotal flap (3.0 cm x 1.5 cm-7.0 cm x 1.5 cm) to repair urethra.

RESULTS

The incision of 38 cases healed by first intention, and no complication occurred. At 7 days after operation, 4 cases had urinary fistula at either coronary sulcus or anastomotic stoma, one of which spontaneously closed 2 months after operation and the rest 3 recovered by repairing urinary fistula 6 months after operation. All patients were followed for 3-48 months (average 18 months). Urination was smooth, the reconstructed urethral opening was at the tip of glans peins without retraction and with appearance similar to the normal urethral opening. The appearance of penis and scrotum was satisfying, and the penis was straightened completely.

CONCLUSION

Combined buccal mucosal graft and scrotal flap, with considerable tissue for urethra tract reconstruction and low incidence rate of urethral stricture, is one of the effective methods to repair hypospadias.