Ten-year experience with composite bladder mucosa-skin grafts in hypospadias repair

Abstract

Objectives: A variety of surgical techniques and flaps have been described for hypospadias repair. We present our 10-year experience using a composite urethroplasty graft consisting of bladder mucosa and skin.

Methods: We reviewed the records of 294 patients who had undergone hypospadias repair at our institution from 1993 to 2003. The meatus was penile in 221, penoscrotal in 55, and perineal in 18. They all underwent single-stage urethroplasty consisting of a composite tubularized bladder mucosa-skin graft. Patient age at surgery was 2 to 46 years old (mean 8.9).

Results: Urethrocutaneous fistula formation occurred in 27 (9.1%) and urethral strictures in 9 (3.2%), for an overall complication rate of 12.3%. No proximal urethral anastomotic strictures or meatal stenosis developed.

Conclusions: Our results have demonstrated that composite bladder mucosa-skin flap grafts can be used successfully for urethral reconstruction in proximal, as well as distal, hypospadias repair. The distal tubularized skin flap prevented the occurrence of meatal stenosis.