Single stage dorsal inlay buccal mucosal graft with tubularized incised urethral plate technique for hypospadias reoperations.
OBJECTIVE
To report the experience with single stage dorsal inlay buccal mucosal grafts using the Snodgrass technique for complex redo cases.


METHODS
From May 2004 to December 2005, a total of 53 patients aged from 3 to 34 years old (average 11.62 +/- 7.18 years) with failed previous hypospadias surgery were included in the present study. Indications included urethral strictures and repair breakdown. The unhealthy urethra was unroofed from the meatus in the ventral midline, a buccal mucosal graft was inlayed between the incised urethral plate and fixed to the corpora cavernosa. The neourethra was tubularized, and covered with subcutaneous (dartos) tissue and penile skin. Glanuloplasty was also performed in all cases. Outcome analysis included clinical follow-up, and endoscopy in 2 selected cases.


RESULTS
The buccal mucosal graft was 3.0-7.5 cm in length and 0.7-2.0 cm in width. All patients required glanuloplasty, with buccal mucosal grafts extended to the tip of the glans. After a follow-up of 14-30 months (mean 22.6 months), the total complication rate was 15.1%, with five cases of fistula and three cases of stricture.


CONCLUSIONS
Inlaying dorsal buccal mucosal grafts applying the Snodgrass technique is a reliable method for creating a substitute urethral plate for tubularization. The recurrent rate of urethral stricture and fistula is at an acceptable level for redo cases. This approach represents an effective, simple and safe option for reoperations.
Ye
Wei-Jing
WJ
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Ping
Ping
P
Liu
Yi-Dong
YD
Li
Zheng
Z
Huang
Yi-Ran
YR
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D055502:Secondary Prevention; D019737:Transplants; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000517:prevention & control; D014548:Urinary Fistula / Q000517:prevention & control; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects / Q000379:methods*