Background/Aims/Objectives: To report the outcome of staged urethroplasty with buccal mucosa and vascularised scrotal flap after failed hypospadias surgery. Methods:n = 35. Inclusion criteria: 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. Complications: 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.

Keywords:
Hypospadias, Buccal mucosa graft, Vascularised scrotal flap
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© 2017 S. Karger AG, Basel
2017
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