“Hanging” of the Buccal Mucosal Graft for Urethral Stricture Repair After Failed Hypospadias

• Published in: The Journal of urology Vol. 185; no. 6; pp. 2479 - 2482
• Main Authors: Djordjevic, Miroslav L, Kojovic, Vladimir, Bizic, Marta, Majstorovic, Marko, Vukadinovic, Vojkan, Korac, Gradimir
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2011; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Humans; hypospadias; Hypospadias - complications; Hypospadias - surgery; Male; Malformations of the urinary system; Medical sciences; mouth mucosa; Mouth Mucosa - transplantation; Nephrology. Urinary tract diseases; transplants; Treatment Failure; urethra; urethral stricture; Urethral Stricture - etiology; Urethral Stricture - surgery; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urologic Surgical Procedures, Male - methods; Urology; urethral stricture; hypospadias; mouth mucosa; urethra; transplants; Nephrology; Urinary system disease; Urethral disease; Hypospadias; Mucosa; Urinary tract disease; Urology; Oral cavity; Urethra; Malformation; Graft; Repair; Urethral stenosis
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2011.01.036

Purpose Urethral stricture is the second most common complication of hypospadias repair after urethrocutaneous fistula. Usually more than 1 procedure is needed for correction due to a lack of available tissue after previous repairs. We evaluated 1-stage urethral stricture management after hypospadias repair using a ventral buccal mucosal graft. We describe the importance of graft hanging and coverage. Materials and Methods From August 2004 to April 2009, 15 patients 9 to 17 years old underwent urethral stricture repair after failed hypospadias surgery. Mean time after primary surgery was 7.2 years (range 4 to 13). Vascularized periurethral tissue around the stenotic part of the neourethra was dissected. The urethra was opened ventrally and a buccal mucosal graft of appropriate size was inserted to allow urethral augmentation. Using several U stitches the graft was anchored to the surrounding periurethral tissue to prevent its folding and retraction. Recurrent chordee in 12 patients and secondary vesicoureteral reflux in 3 were also corrected at this time. Results Mean followup was 37 months (range 17 to 73). Successful results were confirmed in all patients by urethrography and uroflowmetry. One urethral fistula was corrected 3 months later by minor surgery. Recurvature did not develop in this group. There was no recurrent reflux in endoscopically treated patients. Conclusions Ventral buccal mucosal grafting is a simple, safe option for urethral stricture repair. Hanging the graft to periurethral tissue is important for its survival and to prevent postoperative folding and retraction.