title: Tunneled buccal mucosa tube grafts for repair of proximal hypospadias.
abstract: OBJECTIVE
  Buccal mucosa is the favored graft material for patients with long urethral defects and a paucity of skin. Since 2007, we have used the novel tunneled buccal mucosa tube graft urethroplasty technique in these patients. We describe this operative technique and report our surgical and functional outcomes.
  
  
  METHODS
  Between 2007 and 2013, 37 males with proximal hypospadias underwent tunneled buccal mucosa tube graft urethroplasty. After the penile shaft was optimized at a prior stage a free buccal graft was tubularized and tunneled under the intact ventral shaft skin and into the glans. We retrospectively reviewed all charts to report our results. We assessed uroflowmetry and bladder ultrasound for post-void residual urine.
  
  
  RESULTS
  The overall complications rate in 34 patients with more than 1-year followup was 32% (11), including fistula in 5, proximal stricture in 4 and meatal stenosis in 2. In the first 10 patients a total of 7 complications (70%) developed but there were only 4 complications in the next 24 (16%). Surgeon experience was the only significant predictor of complications (p = 0.003). We obtained uroflow and post-void residual urine data on 13 of 37 patients, of whom 9 achieved a normal flow pattern and post-void residual urine, and 4 had a blunted flow pattern.
  
  
  CONCLUSIONS
  The novel technique of the tunneled buccal mucosa tube graft in patients with proximal hypospadias represents a good alternative for a long urethroplasty in patients with a paucity of skin. After the learning curve plateaus the rate and degree of complications decrease. Furthermore, voiding function is adequate, as assessed by uroflow studies and post-void residual urine measurement.
authors: Cohen Children's Medical Center, Hofstra North Shore-LIJ School of Medicine, Flushing, New York. Electronic address: rog2003@gmail.com.
authors: Ronnie
authors: R
authors: Fine
authors: Cohen Children's Medical Center, Hofstra North Shore-LIJ School of Medicine, Flushing, New York.
authors: Edward F
authors: EF
authors: Reda
authors: New York Medical College, Valhalla, New York.
authors: Paul
authors: P
authors: Zelkovic
authors: Cohen Children's Medical Center, Hofstra North Shore-LIJ School of Medicine, Flushing, New York.
authors: Jordan
authors: J
authors: Gitlin
authors: Maimonides Medical Center, Brooklyn, New York.
authors: Jaime
authors: J
authors: Freyle
authors: New York Medical College, Valhalla, New York.
authors: Israel
authors: I
authors: Franco
authors: Cohen Children's Medical Center, Hofstra North Shore-LIJ School of Medicine, Flushing, New York.
authors: Lane S
authors: LS
authors: Palmer
mesh_terms: D000714:Anastomosis, Surgical; D064592:Autografts; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D059032:Learning Curve; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery*; D014563:Urodynamics
keywords: autografts; hypospadias; mouth mucosa; reconstructive surgical procedures; urethra