A Two-Stage Buccal Mucosal Graft (BMG) for Managing Recurrent Proximal Penile Hypospadias in Pediatric & Adolescent Populations

Abstract

Introduction: The presence of a recurrent proximal penile hypospadius represents a surgical challenge to the urologist due to the presence of excessive scarring and fibrosis of the tissues. This problem is more pronounced in circumcised patients, in whom there is no enough skin for one stage procedures. Buccal mucosal grafts represent a good surgical option. The aim of this study was to evaluate the results of two stages buccal mucosal urethroplasty in pediatric & adolescent patients, presenting with recurrent proximal penile hypospadias who are circumcised. Methods: Thirty seven pediatric & adolescent patients underwent two stages buccal mucosal urethroplasty for recurrent proximal penile hypospadius. In all cases the buccal graft was placed dorsally followed by the second stage closure after 6 months. Results: The mean age was 17.7 (14-20) years. With a mean follow-up of 28.3 months, 33 patients (89.2%) had a final successful outcome. Of the 4 cases that were considered as failure, 3 patients (8.1%) developed urethra-cutaneous fistula that required closure after 3 months. The remaining patient developed meatal stenosis. Conclusion: Although buccal mucosal urethroplasty is a two staged procedure, it is feasible option for pediatric & adolescent patients presenting with recurrent proximal penile hypospadius, who had no skin available for penile flaps, with a success rate approaching 89.2%.