Objective: Free buccal mucosal graft is one of the outstanding alternatives when the genital tissue
is fibrous or deficient. We would like to present our small experience with buccal
mucosa on-lay graft for the treatment of anterior urethral stricture and recurrent
urethra-cutaneous fistula after hypospadias repair in children.
Methods: Among October 2004 to March 2007 we operated upon eleven male
patients. Their age ranged from 3-12 years old. Free buccal mucosal on-lay grafts
from the internal part of the lower lip were taken for three cases of complicated
anterior urethral stricture and for eight cases of recurrent urethra-cutaneous fistula
after earlier numerous penile hypospadias repairs.
Eleven on-lay free grafts were ventrally positioned on the penile urethra. The grafts
extent ranged from 0.5 to 6 centimeters. All these operations were performed in one
stage by a single surgeon and his team. The follow up time was from 2 to 5 years.
Results: The achievement was perfect in 8 out of 11(73%) patients. Urethral
complications occurred in three cases which were apparent by one month and three
months postoperatively. The first one had severe proximal and distal urethral
strictures which ultimately required a proximal urethrostomy as a first stage. The
second one had a mild stenosis which requisite two meatal dilatations and at last a
meatoplasty. The third one had a small fistula which was simply closed later. One
patient developed a hypertrophied scar at the harvest site which unexpectedly
resolved over a period of three months.
Conclusion: Complex hypospadias surgery is taxing and should be done by an
experienced pediatric surgeon. Utilizing the buccal mucosa in case of deficient genital
skin is an efficient, handy and secure skill of managing the crippled cases that need
redo surgery.
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Key words: Hypospadias, buccal, on-lay graft
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