Objectives: To share our experience in hypospadias repair and discuss the clinical implications of our method, which consists of a combined buccal mucosa graft and local flap for urethroplasty. Patients and Methods: 1,394 cases (median age 11.3 years, age range 5 months to 53 years) of hypospadias which were repaired using our method between July 2000 and December 2010 in our department were included in this study. The patients who had a short penis or did not have chordee were excluded from the data. 588 cases (42.2%) had previously undergone surgery in other hospitals but failed; 806 (57.8%) cases had undergone the first treatment in our department. Results: Of the 806 cases which had undergone the first treatment in our department, we successfully reconstructed the urethra for 747 patients (92.3%), and 59 patients had complications (7.7%); of the 588 cases which had previously undergone surgery but failed, we successfully reconstructed the urethra for 522 patients (88.8%), and 66 patients had complications (11.2%). The most common complication was urethra fistula (70; 5%); other complications include necrosis of the skin flap and infection resulting in wound disruption (19; 1.4%), urethral diverticula (11; 0.8%) and urethral stricture (25; 1.8%). Conclusions: Our method appears to be a safe, simple and satisfactory surgical procedure and can provide relatively enough tissue to reconstruct the urethra with a higher success rate.

1.
Roberts J: Hypospadias surgery past, present and future. Curr Opin Urol 2010;20:483-489.
2.
Snodgrass W: Tubularized, incised plate urethroplasty for distal hypospadias. J Urol 1994;151:464-465.
3.
Li Q, Li S, Chen W, Xu J, Yang M, Li Y, Wang Y, Zhao Z: Combined buccal mucosa graft and local flap for urethral reconstruction in various forms of hypospadias. J Urol 2005;174:690-692.
4.
Djordjevic ML, Kojovic V, Bizic M, Majstorovic M, Vukadinovic V, Korac G: ‘Hanging' of the buccal mucosal graft for urethral stricture repair after failed hypospadias. J Urol 2011;185:2479-2482.
5.
Andrich DE, Mundy AR: Substitution urethroplasty with buccal mucosal-free grafts. J Urol 2001;165:1131-1133, discussion 1133-1134.
6.
Caldamone AA, Edstrom LE, Koyle MA, Rabinowitz R, Hulbert WC: Buccal mucosal grafts for urethral reconstruction. Urology 1998;51:15-19.
7.
Acimi S: Comparative study of two techniques used in distal hypospadias repair: tubularized incised plate (Snodgrass) and tubularized urethral plate (Duplay). Scand J Urol Nephrol 2011;45:68-71.
8.
Snodgrass WT, Bush N, Cost N: Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol 2010;6:408-413.
9.
Tiryaki T: Combination of tubularized island flap and ventral skin flap techniques in single-stage correction of severe proximal hypospadias. Urol Int 2010;84:269-274.
10.
Macedo AJ, Srougi M: Onlay urethroplasty after sectioning of the urethral plate: early clinical experience with a new approach - the ‘three-in-one' technique. BJU Int 2004;93:1107-1109.
11.
Orkiszewski M, Madej J: The meatal/urethral width in healthy uncircumcised boys. J Pediatr Urol 2010;6:130-133.
12.
De Mattos e Silva E, Gorduza DB, Catti M, Valmalle AF, Demede D, Hameury F, Pierre-Yves M, Mouriquand P: Outcome of severe hypospadias repair using three different techniques. J Pediatr Urol 2009;5:205-211, discussion 212-214.
13.
Aldaqadossi H, El Gamal S, El-Nadey M, El Gamal O, Radwan M, Gaber M: Dorsal onlay (Barbagli technique) versus dorsal inlay (Asopa technique) buccal mucosal graft urethroplasty for anterior urethral stricture: a prospective randomized study. Int J Urol 2014;21:185-188.
14.
Srivastava A, Vashishtha S, Singh UP, Srivastava A, Ansari MS, Kapoor R, Pradhan MR, Kapoor R: Preputial/penile skin flap, as a dorsal onlay or tubularized flap: a versatile substitute for complex anterior urethral stricture. BJU Int 2012;110:E1101-E1108.
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