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Introduction:Urethral stricture in patients who have had prior hypospadias repairs in childhood presents a challenge. For patients with an extensively scarred urethral plate and patients with BXO we have opted for a two-stage repair, otherwise a one-stage repair was performed. Herein we report on our experience with the one-stage repair using either a flap of penile skin or a buccal mucosa graft in 29 patients
Materials and Methods: Between 1993-2007 one stage urethroplasty was performed in 32 children and young adults (10-29 years old) of whom 3 are excluded because of incomplete records. Group 1 patients (n=14) underwent an island skin flap onlay and Group 2 patients (n=15) underwent buccal mucosa graft onlay. All patients had relatively healthy, but often narrow urethral plates, and all repairs were waterproofed by either a generous Dartos or tunica vaginalis flap. Patients were followed-up at 3 months, 6 months, 2 years and in 14 patients for 5 years.
Results: Mean stricture length was 7.1 cm in Group 1 (3-10 cm) and 7.5 cm in Group 2 (2-12 cm). A total of 19 patients (65.5%) had an associated urethrocutaneous fistula. Penile curvature was present in 4/14 patients (28.5%) in Group 1 and 5/15 patients in Group 2 (33.3%) which was addressed at the time of surgery. Postoperative complications occurred in 2 patients in Group 1 (14.2%) and 2 patients in Group 2 (13.3%). Urethral fistula occurred in one patient (7.1 %) in Group 1 and one patient (6.6%) in Group 2. Re-stricture occurred in one patient (7.1 %) in Group 1 and one patient (6.6%) in Group 2. In Group 1 the fistula was closed and the recurrent stricture was successfully corrected by buccal mucosa graft onlay. In Group 2 the patient who developed a urethral fistula declined closure and the patient with recurrent stricture elected to perform self-dilation. Follow up cystoscopy and/or urethral calibration was performed at 3 months, 6 months and 2 years in all patients. In the final analysis 28/29 patients are stricture free and have reported no complaints of recurrent obstruction
Conclusion: The integrity of the residual urethral plate and quality of the available penile skin must be carefully evaluated prior to deciding on the type of repair. One-stage onlay repair using island skin flap or buccal mucosa graft for urethral strictures following hypospadias repair are equally successful in patients who have a healthy residual urethral plate, regardless of its width. The choice of either technique should be based on the quality of the penile skin and surgeon's preference