An objective analysis of > 600 paired hypospadias graft measurements: Prepuce vs oral graft take and HBOT effect.

INTRODUCTION

Urethroplasty graft outcomes have traditionally been assessed subjectively, limiting comparison and understanding of graft success. We used standardized graft measurements to objectively evaluate graft take in primary prepucial and reoperative oral grafts, and assessed the effect of hyperbaric oxygen therapy (HBOT) in reoperations.

AIMS: Primary: Validate graft area measurement as an bojective tool to compare graft take between primary and reoperative grafts. Secondary: Correlate graft contracture with complications. Tertiary: Evaluate HBOT's impact in reoperations.

METHODS

A Prospective cohort of staged hypospadias repairs (2014-2023) was studied, excluding single-stage repairs. A two-stage STAG or three-stage STAC technique was used. Prepuce was used in primary grafts, oral mucosa in reoperations. Graft length and width were measured at placement and tubularization to calculate graft area take. Complications and HBOT use were documented. HBOT was administered post-placement in reoperations as per protocol.

RESULTS

627 grafts were analyzed. Graft take was 93 % in prepucial grafts, 92 % in +HBOT oral grafts, and 83 % in -HBOT (p = 0.011). Graft contracture and failure significantly predicted complications. HBOT significantly reduced these risks.

CONCLUSIONS

Standardized graft measurement reliably assesses graft take. Contracture ≥20 % predicts higher complications. HBOT improves outcomes in reoperations to levels seen in primary repairs.