title: The multistage use of buccal mucosa grafts for complex hypospadias: histological changes.
abstract: OBJECTIVE
  We report our experience using buccal mucosa in the multistage repair of complex hypospadias, and the observed histological changes.
  
  
  METHODS
  We evaluated 31 patients (14 adults and 17 children). A total of 19 patients presented after failed hypospadias repair with deficient ventral skin, 5 presented with scrotal hypospadias and 7 presented with perineal hypospadias. Patients who had previously undergone hypospadias repair had 3 to 7 failed trials. Two stage buccal mucosa graft was performed using the Bracka technique. In the first stage residual fibrosis was released, the glans was split and the buccal mucosa graft was sutured to the ventral surface of the penis to form a future urethral plate. Second stage reconstruction was performed after 6 months with interposed scrotal dartos tissue. Buccal mucosa was histologically studied before grafting, and at 6 months after graft uptake and exposure to the air.
  
  
  RESULTS
  Buccal mucosa free graft showed excellent uptake within 5 days in all cases. At 6 months the buccal mucosa was well vascularized and pliable. Minute fistulas occurred in 3 cases (9.7%), which were closed at a later stage. Histological analysis of buccal mucosa tissues before and after graft and prolonged exposure to the air (more than 6 months) was conducted. The buccal mucosa displayed epithelial hyperplasia with mild and focal keratinization. The lamina propria was slightly edematous and minimally infiltrated by mononuclear inflammatory cells. The lamina propria papillae were elongated, extending to 75% of the mucosal thickness compared to the normal buccal mucosa. The buccal mucosal graft displayed good vascularization, similar to that of the normal mucosa.
  
  
  CONCLUSIONS
  Multistage repair using buccal mucosa is an excellent option for urethral reconstruction. It guarantees excellent graft uptake and good vasculature, which improves success. It also provides supple tissue for glanular and urethral reconstruction in cases of severe complex hypospadias.
authors: Department of Urology, Section of Pediatric Urology and Department of Pathology, Alexandria University, Alexandria, Egypt. ibrahim_mokhless@yahoo.com
authors: Ibrahim A
authors: IA
authors: Mokhless
authors: Mona Abdel
authors: MA
authors: Kader
authors: Nader
authors: N
authors: Fahmy
authors: Mohamed
authors: M
authors: Youssef
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D013521:Urologic Surgical Procedures, Male / Q000379:methods