title: Management of hypospadias cripples with two-staged Bracka's technique.
abstract: Patients labelled as 'hypospadias cripples' pose a challenge to reconstructive surgeons because of the complexity of the problem and limited options for reconstruction. The two-staged Bracka method is a versatile technique that is relatively easy to learn and applicable in difficult cases of salvage hypospadias. Over a period of 8 years, we applied this technique to 100 patients with hypospadias cripples who had previously undergone multiple (3-16) procedures. In the first stage, a full-thickness graft of skin or buccal mucosa was used for urethral plate reconstruction after release of chordee. Stage II was carried out at least 6 months after the first procedure. Meatal opening at the tip of the glans was achieved in 94 patients, straightening of the penis in 96 and proper urinary stream in 92 patients. Fistula formation occurred in nine patients. In our opinion, the two-staged Bracka technique is a useful strategy to deal with the myriad abnormalities encountered in crippled hypospadias. This technique not only creates a neourethra successfully, but also gives the penis a near-normal shape and appearance.
authors.affiliation: Department of Plastic & Reconstructive Surgery, Shaikh Zayed Hospital, Lahore, Pakistan. naumangill22@yahoo.co.uk
authors.forename: Nauman Ahmad
authors.initials: NA
authors.lastname: Gill
authors.forename: Abdul
authors.initials: A
authors.lastname: Hameed
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D008297:Male; D010154:Pakistan; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery; D014554:Urination / Q000502:physiology; D055815:Young Adult