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Buccal Mucosa Tube Graft for Failed Hypospadias Repair: Worth it or Not?

  • Sang Woon Kim
    Affiliations
    Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Yong Seung Lee
    Affiliations
    Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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  • Sang Won Han
    Correspondence
    Address correspondence to Sang Won Han, M.D., Department of Urology, Urological Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
    Affiliations
    Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
    Search for articles by this author
Published:September 07, 2020DOI:https://doi.org/10.1016/j.urology.2020.07.065

      Objective

      To report the outcome of buccal mucosa tube graft (BMTG) over time in correcting failed hypospadias.

      Methods

      We conducted a retrospective analysis, reviewing charts of all 69 patients who underwent BMTG to repair hypospadias between January 2005 and October 2016. Twenty-one patients were excluded, leaving 48 eligible study subjects. In patients with penile curvatures, corrective procedures (including urethral division, corporoplasty, and local skin flap) took place prior to grafting.

      Results

      Mean age at surgery was 8.96 years, and mean duration of follow-up was 73.10 ± 30.31 months. A mean of 1.88 previous surgeries was recorded. During follow-up, only 7 patients (14.5%) were complication free. The other 41 patients required at least 1 additional procedure. Stricture-free rates were 50%, 35.4%, and 27% at 1, 3, and 12 months after BMTG, respectively. Among 37 patients with postoperative stricture, 25 were treated only by endoscopic procedures. Single operation prior to BMTG (P= .004) and usage of larger catheter size (>8Fr) (P = .029) were confirmed significant factors associated with better stricture-free survival after BMTG by log-rank test. After several additional procedures, 46 patients (95.8%) reported normal urination with mean maximal urinary flow of 9.55 mL/s and post-void residual of 16.08 mL for at least 12 months on last visit.

      Conclusion

      BMTG after failed hypospadias repair seems prone to complications, primarily urethral stricture. However, a large number of patients with postoperative stricture could be treated simply by endoscopic procedures. Given the better results of staged approach, BMTG should be only applied to highly selected patients with failed hypospadias.
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