title: Our experience of proximal hypospadias repair using the Cloutier-Bracka technique at the Gynaeco-Obstetric and Paediatric Hospital, Yaounde-Cameroon.
abstract: BACKGROUND
  In parts of Africa, routine circumcision is practised and sometimes even on children with hypospadias. The lack of preputial foreskin renders urethroplasty more difficult and often requires to use of a mucosal graft as described by Bracka.
  
  
  OBJECTIVE
  The authors describe their experience of hypospadias repair using Bracka's technique.
  
  
  METHODS
  Over a period of 5 years, 100 cases of proximal hypospadias were operated in our institution. All patients aged 0-18 years who had already been circumcised were included in this study.
  
  
  RESULTS
  The outcome of the 12 cases operated according to Bracka's technique was analysed. The mean age was 11.5 years. The ectopic meatus was penoscrotal in three cases, scrotal in one case and perineal in eight cases. After reconstruction, the new meatus was sutured at the top of the glans in one case, at the prepuce in seven cases and at the penile midshaft in one case. The main complications noted were surgical site infection, wound dehiscence, residual chordee and urethrocutaneous fistula. No neourethral stenosis nor uretrocele was recorded.
  
  
  CONCLUSIONS
  The buccal mucosal graft urethroplasty as described by Bracka is associated with a lower risk of meatal strictures compared to other free mucosal grafts. The buccal mucosa is easier to harvest and causes less scarring than bladder mucosa.
  
  
  CONCLUSIONS
  Repair of severe hypospadias remains a challenge for paediatric surgeons. The functional and cosmetic outcomes depend on the choice of the donor site for the graft and objective assessment of successful reconstruction criteria during follow-up.
authors.affiliation: Yaounde Gynaeco-obstetric and Paediatric Hospital, Cameroon.
authors.forename: Mouafo Tambo
authors.initials: MT
authors.lastname: Faustin Felicien
authors.affiliation: Yaounde Gynaeco-obstetric and Paediatric Hospital, Cameroon.
authors.forename: A S
authors.initials: AS
authors.lastname: Nwaha Makon
authors.affiliation: Yaounde Gynaeco-obstetric and Paediatric Hospital, Cameroon.
authors.forename: C
authors.initials: C
authors.lastname: Kamadjou
authors.affiliation: Yaounde Gynaeco-obstetric and Paediatric Hospital, Cameroon.
authors.forename: G
authors.initials: G
authors.lastname: Fossi
authors.affiliation: University of Geneva Teaching Hospital, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Le Coultre
authors.affiliation: Yaounde Gynaeco-obstetric and Paediatric Hospital, Cameroon.
authors.forename: O G
authors.initials: OG
authors.lastname: Andze
authors.affiliation: Department of Surgery and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.
authors.forename: M A
authors.initials: MA
authors.lastname: Sosso
authors.affiliation: Lyon Teaching Hospital, France.
authors.forename: P Y
authors.initials: PY
authors.lastname: Mure
mesh_terms: D000293:Adolescent; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D052816:Foreskin / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*