Elsevier

Urology

Volume 146, December 2020, Pages 196-200
Urology

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

https://doi.org/10.1016/j.urology.2020.07.065Get rights and content

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.

Section snippets

Patient Selection

We retrospectively reviewed medical records of all 69 consecutive patients undergoing BMTG for repair of hypospadias at our institution between January 2005 and October 2016. Excluding 18 patients, for whom urethroplasty was undertaken as initial hypospadias repair, and 3 who were lost to follow-up, a total of 48 patients who underwent surgery for correction of failed hypospadias repair and were followed for a minimum of 12 months qualified for study. We recorded the duration of follow-up for

RESULTS

Mean age at the time of surgery was 8.96 ± 7.32 years, and the median follow-up period was 65.50 months (range: 31-162 months) (Table 1). All patients had undergone a variety of primary hypospadias corrections and related surgeries due to ensuing complications (range, 1-5 procedures; average, 1.94 ± 1.19). Having faced multiple interventions years before seeking our care, some patients had lost count and were unable to indicate with certainty the original primary meatal locations. Initial

DISCUSSION

To our knowledge, this is the largest study using BMTG to treat hypospadias after failed repairs. Herein, we determined the success rate of this approach and critically analyzed related complications. Although there have been several reports to date of similar studies, they have been hampered by the heterogeneity of their patient populations and surgical techniques.3, 4, 5, 6 To better understand postoperative patient courses in this setting, we analyzed outcomes and complications over time,

CONCLUSION

Although BMTG after failed hypospadias repair seems prone to complications (mainly strictures), postoperative urethral strictures after BMTG were not usually lengthy and were treatable in many cases by endoscopic surgery. Nevertheless, BMTG in treatment of failed hypospadias should be applied only to highly selected patients, given that postoperative complications are more common than staged approach, even in patients with good prognostic factors.

Authors Contribution

Sang Woon Kim: Data collection or management, Data analysis, Manuscript writing/editing. Yong Seung Lee: Data collection or management, Data analysis. Sang Won Han: Project development, Manuscript writing/editing.

Conflict of interest

The author declares that they have no competing interest.

Research involving human participants and/or animals

The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study, informed consent is not required.

Supplementary Figure 1. Buccal mucosa tube graft in treatment of failed hypospadias; (A) penile appearance 6 months after skin flap and urethral division; (B) postoperative shape after buccal mucosa tube graft showing catheter and minimal incision

Financial disclosures: The authors declare that they have no relevant financial interests.

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