Two-stage repair with buccal mucosa for severe and complicated hypospadias in adults

Objectives: To report the outcomes of two-stage repair for adult hypospadias using a buccal mucosa graft as a tube. Methods: A total of 57 adult patients who underwent surgery for severe urethral defect at our institution from January 2002 to March 2010 were included in this analysis. The urethroplasty procedure included penile urethra reconstruction with the buccal mucosa graft used as a tube in the first stage, anastomosis of the unobstructed urethra in the second stage and a scrotal fascio-cutaneous flap transferred to resurface the reconstructed urethra for waterproofing. Results: No complications occurred after the first stage, whereas postoperative infections occurred in six cases and distal necrosis of the scrotal flap occurred in two cases after the second stage. All eight of these patients had the complication of urethrocutaneous fistula, which healed after 2-4 weeks by cleaning and changing dressings in six patients. Twelve patients complained of straining at voiding in the early postoperative period. However, nine of these patients had an obvious increase in maximum flow rate without any intervention 3 months after the operation. Follow up ranged from 6 to 62 months (mean 28 months) in 46 patients. Most of the patients presented terminal meatus, no chordee, no urethral stricture and normal voiding. The majority of patients achieved excellent cosmetic and functional results. Conclusions: A buccal mucosa graft as a tube is a reliable and durable method of two-stage repair for severe and complicated hypospadias in adults. The use of scrotal flaps seems to contribute to a good vascularized waterproof cover.