Outcomes of staged Lingual Mucosal Graft Urethroplasty for complex hypospadias repair
Hussein A. Aldaqadossi, M.D.1, Hossam Shaker, M.D.1, Hamada Youssof, M.D.1, Youssof Kotb, M.D.2, Mahmoud Eladawy, M.D.1.
1Fayoum University, Fayoum, Egypt, 2Ain Shams University, Ain Shams, Egypt.
Outcomes of staged Lingual Mucosal Graft Urethroplasty for complex hypospadias repair.
Purpose:
The objective of this study is to present the outcomes of complex of hypospadias repair using lingual mucosal graft (LMG)
Patients and methods:
Between June 2012 and February 2017, 47 patients underwent staged LMG urethroplasty for redo hypospadias repair. Inclusion criteria were previous failed hypospadias repair, paucity of local skin which interferes with correction using skin flaps, and demands graft urethroplasty. During the first stage a well vascularized bed on the tunica albuginea was created. Then the harvested LMG was secured to the prepared bed. The second stage urethroplasty was carried out after 6 months. In this stage tubularisation of previously implanted LMG was performed. In 4 cases tubularisation was difficult due to graft contracture. We managed this difficulty by using the dorsally degloved penile skin as onlay island flap in 3 cases and buccal mucosa onlay graft in the fourth case. In all cases a second protective layer from dartos or tunica vaginalis was developed to cover the neourethra.
Results:
The mean (SD) age of patients at first stage was 5.43 (1.98) years, and the mean (SD) duration between both stages was 7 (1.16) months. The mean (SD) follow up after the second stage was 15.11 (3.08) months. The mean (SD) number of previous operations was 2.32 (0.78). The mean (SD) length of LMG was 3.13 (0.99) cm and the width was 1.36 (0.55) cm. No donor site major complications, but mild oral discomfort in the first week after graft harvesting was reported in 39 (82.98%) patients. After the second stage complications were reported in 9 (19.15%) patients, including meatal stenosis in 5 and fistula in 4. The reported success rate was 80.85%. Conclusions:
Two-stage LMG urethroplasty is a reliable procedure for salvage urethroplasty. LMG harvesting is easy with minor oral complications. 
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