Refinements in buccal mucosal grafts urethroplasty for hypospadias repair.

We evaluated our experience with buccal mucosa in urethral reconstruction for complex hypospadias repair in a total of 62 children operated on at our institution since 1990 at a mean follow-up of 23 months. After the graft had been taken from the lower lip, with possible extension to the inner cheek, complete thinning of the graft was performed. The graft was then sutured in an onlay fashion to the urethral plate, and suprapubic urinary diversion was carried out for 3 weeks. The overall complication rate in this rather complex series of patients, including 26 "hypospadias cripples," was 13%; the complications involved 4 fistulas, 3 cases of graft necrosis, and only 1 meatal stenosis during the follow-up period. These favorable results prompted us to use buccal mucosa onlays as our current method of choice for urethral reconstruction with avoidance of tubularized repairs. The definite value of this technique, however, will become evident only after a longer follow-up period and confirmation of these favorable results.