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Combined Corporo-Urethral Grafting using Buccal Mucosa for Proximal Hypospadias with Significant Penile Curvature.
Ashraf S. Soliman, Lecturer of Urology, Mohamed E. Youssif, Assistant Professor of Urology, Ahmed M. Fahmi, Lecturer of Urology, Ahmed G. Hanno, Professor of Urology, Ibrahim A. Mokhless, Professor of Urology.
Faculty of Medicine, University of Alexandria, Alexandria, Egypt.

BACKGROUND:
Proximal hypospadias with significant curvature is a surgical challenge. Corporal grafting can solve the problem of corporal disproportion but necessitate the use of another flap for urethral reconstruction to avoid the application of a graft over a graft. The epithelized surface of the buccal graft can also hinder the application of the overlying grafts in other cessions. We describe a technique by which the buccal mucosal graft is used for corporal grafting and in the same time incorporated in urethral plate reconstruction.
METHODS:
In the period from June 2008 to December 2012, 10 cases of proximal penile hypospadias with associated sever curvature due to corporal disproportion were operated upon using this technique. Age range 10 months to 14 years. Technique: Degloving and dissection of the penis was done with preservation of the urethral plat, Gett's test was done, followed by transection of the urethral plate when indicated, Cases with residual penile curvature more than 30 degrees were candidate for the procedure. The point of maximal curvature was marked and incision of the tunica albogenia was done along this line. A longitudinal strip of labial mucosa was used in 8 cases and extended labiobuccal graft in 2 cases. The central part of the graft was sutured to the corporal defect to act as a corporal graft with its epithelized surface to the outside to be incorporated in the new urethral plate. The free proximal and distal wings of the grafts are used as urethral inlay graft. Fenestration of the graft was avoided in the central part. Tucking sutures was also avoided in the central part. Tie over was applied for 5 dayes. Six month following the graft take, second stage was done using the new urethral plate and surrounding penile skin for urethral reconstruction. Tunica vaginalis was used for 2nd layer covering in all cases. Supra pubic catheter was fixed in all cases. Urethral catheter was removed 8 to 10 days post operative. Supra pubic catheter was removed 2 dayes later after ensuring good voiding.
RESULTS:
Follow up of all cases was done for 1 to 54 months, Penoscrotal fistula was encounterd in one case and closed successfully. Partial skin dehiscence in 2 cases and managed with local care. Straight penis was established in all cases.
CONCLUSIONS:
This technique is feasible for the management of severe cases of proximal hypospadias with urethral defect and corporal disproportion


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