Reconstruction of hypospadias and epispadias with buccal mucosa free graft as primary surgery: more than 10 years of experience.

Abstract

The most common techniques to reconstruct the urethra for severe hypospadias or epispadias involve use of the genital skin. Buccal mucosa free graft is usually used in a second operation due to a paucity of usable genital tissue. We report our experience using buccal mucosa free graft as primary surgery for hypospadias and epispadias. Between 1989 and 2001 the urethra was reconstructed using buccal mucosa free graft as a primary operation in 22 patients 3 to 13 years old with middle or proximal hypospadias (20) and exstrophy/epispadias (2). In the first 5 cases of hypospadias the buccal mucosa was combined with bladder mucosa. In the 2 exstrophy/epispadias cases treated with the penile disassembly technique the distal part of the urethra was reconstructed with buccal mucosa. At mean 5-year followup 2 cases of urethral fistulas and 1 case of severe stenosis of the proximal anastomosis were observed, which required surgical correction. In 4 other cases mild stenosis of the anastomosis required urethral dilations in the first month after surgery. Buccal mucosa is an excellent source of graft material for urethral replacement in complex urethroplasties as primary surgery. It is readily available, elastic, resistant and technically easy to harvest.