Single stage repair with buccal mucosal graft in hypospadias cripple patients

Background: Hypospadias surgery has developed into a well-defined art and science. Surgeons dealing with this anomaly should have detailed understanding of various basic surgical principles and experience with delicate, precise optically assisted techniques and maintain a clinical workload that is sufficient to obtain consistently good results. Objective of this study was to evaluate the outcome of using buccal mucosal graft for single stage repair in adult hypospadias cripples.Methods: All patients with prior failed hypospadias repair after multiple surgeries presenting in MLN Medical College, Allahabad were included in study. Dorsal onlay buccal mucosa graft with parallel turn over flap from penile skin for ventral surface method was used.Results: Total 20 patients were included in study. Among these 12 patients presented with complete dehiscence of repair, 5 patients presented with multiple urethrocutaneous fistulas, 3 patients presented with extensive stricture formation. Same surgeon performed procedure of dorsal onlay buccal mucosa graft urethroplasty to reduce the bias. Success rate of dorsal onlay substitution free buccal mucosal graft urethroplasty in single stage is affected by scarring of surrounding penile skin. Most common complication related to donor site are transient pain and swelling and to graft site are stricture and fistulas.Conclusions: Single stage repair with buccal mucosal graft in hypospadias cripple patients is an excellent free graft urethroplasty in cases with prior failed primary repair of hypospadias, in whom the preputial skin was lacking or insufficient and a longer urethral tube needed to be constructed.

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Dorsal onlay buccal mucosal graft or penile skin graft substitution urethroplasty in bulbar urethral stricture: compare the outcome and review

International Surgery Journal ◽

10.18203/2349-2902.isj20200535 ◽

2020 ◽

Vol 7 (3) ◽

pp. 664

Author(s):

Atul K. Khandelwal

Keyword(s):

Success Rate ◽

Urethral Stricture ◽

Skin Graft ◽

Buccal Mucosa ◽

Penile Skin ◽

Buccal Mucosa Graft ◽

Buccal Mucosal Graft ◽

Study Results ◽

Dorsal Onlay

Background: Authors describe their experience with dorsal onlay urethroplasty using Buccal mucosal graft or penile skin graft through dorsal sagittal urethrotomy for bulbar urethral stricture.Methods: From 2014 to 2017, 29 male patients with bulbar urethral stricture have been treated by one stage dorsal onlay substitution urethroplasty using buccal mucosal graft and penile skin graft. Patients with balanitis xerotica obliterans, unhealthy penile skin, oral mucosa pathology or those who had undergone more than one urethral dilation/internal urethrotomy or urethroplasty were excluded from study. Results were analyzed at 6th and 12th month follow up with clinical history and uroflowmetry. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilation or optical internal urethrotomy.Results: A total of 16 men age between 21 to 56 years for buccal mucosa graft (BMG) urethroplasty and 13 men age between 18 to 59 years underwent dorsal onlay substitution urethroplasty using BMG and penile skin graft (PSG). Mean stricture length was 4.2 cm (3.8-6) for BMG urethroplasty and 4.1 cm (3.2-5) for PSG urethroplasty. Mean length and width of graft were 4.2 cm and 2.6 cm respectively in BMG urethroplasty while 4.6 cm and 2.5 cm in PSAG urethroplasty. Average follow up months were 13.4 months with overall success rate 87.5% in BMG urethroplasty while average follow up months were 14.6 months with overall success rate 82.3% in PSG urethroplasty.Conclusions: On short term follow up substitution urethroplasty using both penile skin and buccal mucosa graft have comparable results.

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