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Repair Of Complex Hypospadias Using Buccal Mucosa Grafts
Spencer I Kozinn1, Alan Retik2, Richard Lee2, Bartley Cilento2, Stuart Bauer2, Joseph Borer2, Sohee Kim2, David Diamond2
1Lahey Clinic, Burlington, MA;2Childrens Hospital Boston, Boston, MA

Introduction: We aim to describe indications and outcomes for repair of complex hypospadias and chordee in the pediatric population using buccal mucosa grafts.
Methods: We retrospectively identified consecutive patients undergoing complex hypospadias repair using buccal mucosa grafts between 1995 and 2010. Demographic and surgical outcomes data was collected on all patients.
Results: SEE TABLE 1
A total of 21 patients underwent hypospadias repair with buccal graft. Approximately two thirds had penoscrotal/perineal disease, with the remainder mid-shaft or distal. All patients underwent initial repair in early childhood, and 71% were revised, just over half multiple times, prior to undergoing salvage repair using buccal grafts. In 16 patients, a staged approach was utilized with a mean interval of 10.8 months between surgeries, while 5 were completed in a single operation. All but one of the single stage patients required an additional major urethroplasty. Only 4 of the staged cohort necessitated major revision, one of the first stage and 3 of the second. The most common complication was recurrent stricture (8 patients), followed by urethrocutaneous fistula (3 patients), and diverticulum (one patient).
Conclusion: Hypospadias repair with buccal graft in a staged fashion is a good option for the most complex cases. Many of these patients will require revision, however, to achieve ultimate success. Attempts at single stage tubularized grafts had poor Results in this small series.
Table 1

Patient Characteristics
n=21
Mean Age, yrs (range)8.9 (1.33-17)
Indication for Surgery
Repair Breakdown8 (38%)
Fistula4 (19%)
Diverticulum4 (19%)
Stricture/Meatal
Stenosis
13 (62%)
Chordee4 (19%)
Multiple10 (48%)
Mean Graft Length, cm4.3 cm
(1.5-11cm)
Mean Follow-up, mos19


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