Evaluation of Preputial and Buccal Mucosal Grafts in Two-Stage Repair of Severe Proximal Hypospadias

Abstract

Aims: To evaluate the results of staged surgical repair of proximal forms of hypospadias according to Bracka’s method using preputial or buccal grafts in the department of urology, Tanta university hospital between January 2019 and January 2022. Study Design: Prospective comparative randomized study. Place and Duration of Study: Urology department, Tanta university hospital, between January 2019 and January 2022. Methodology: Fifty male patients with severe proximal hypospadias associated with moderate to severe chordee and or poor urethral plate underwent two-stage repair with buccal mucosal or preputial graft in the department of urology, Tanta university hospital between January 2019, and January 2022 cosmetic and functional outcomes were assessed. Results: Native meatus was at proximal penile in 1, penoscrotal in 13, scrotal in 19, and perineal in 17 cases.  25 patients underwent staged hypospadias repair using preputial graft in the 1st stage and 25 patients underwent staged hypospadias repair using buccal mucosal graft. The mean age of the patients at the 1st stage was 9.5 and 8.7 months in the preputial and buccal mucosal groups respectively. The graft take was successful except only in 5 patients needed graft redo after the 1st stage. Success rate was 54.5% with preputial group and was 62% in buccal mucosal group. Conclusions: Two-stage repair with Bracka’s technique is safe and feasible for repair of primary cases of sever proximal hypospadias. Both preputial and buccal mucosal grafts are reliable and suitable urethral substitutes in staged hypospadias repair with comparable results and complications rate.