title: The Staged Urethroplasty with Vascularised Scrotal Flap and Buccal Mucosa Graft after Failed Hypospadias Surgery: A Reliable Technique with a Novel Tool.
abstract: Background/Aims/Objectives: To report the outcome of staged urethroplasty with buccal mucosa and vascularised scrotal flap after failed hypospadias surgery.
  
  
  METHODS
  n = 35.
  
  
  METHODS
  destroyed urethral plate, deficient local skin, fistula and penile deviation. Five out of 35 patients also had a secondary proximal stricture. Stage 1: excision of scarred tissue and fistulae, correction of the penile deviation through dorsal plication and the ventral placement and quilting of buccal graft. Stage 2: tubularisation of the neourethral plate; in 20 patients with deficient penile skin a vascularised scrotal flap was developed and transferred on the tubularised urethra. In 5 patients, the proximal stricture was repaired during a separate operation by using buccal graft, the distal urethra was marsupialised. The repair of the distal urethra was performed later as described above.
  
  
  RESULTS
  Thirty-three patients are recurrence-free without further interventions; successful reoperation was done in 2 cases.
  
  
  RESULTS
  1 graft necrosis; 1 coronary fistula; 1 scrotal flap necrosis and 1 case of hematoma.
  
  
  CONCLUSIONS
  Complicated strictures after multiple failed hypospadias repair are well managed by using buccal graft. The vascularised scrotal flap is a very useful tool in case of deficient and scarred penile skin and could explain the low rate of fistula formation in our series.
authors.affiliation: Department of Urology, Urologic Oncology and Paediatric Urology, Sana Klinikum Hof, Hof, Germany.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Pandey
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Barta-Kelemen
authors.forename: Michael
authors.initials: M
authors.lastname: Borisenkov
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018572:Disease-Free Survival; D006801:Humans; D007021:Hypospadias / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000637:transplantation*; D010413:Penis / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012611:Scrotum / Q000098:blood supply* / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply*; D013997:Time Factors; D017211:Treatment Failure; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D014525:Urethral Stricture / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects*; D055815:Young Adult
keywords: Buccal mucosa graft; Hypospadias; Vascularised scrotal flap