Ventral Onlay Buccal Mucosa Graft in Complex Hypospadias Repair

Hypospadias is the most common penile congenital anomaly [2] and the second most common congenital malformation in males, occurring in approximately one in 125 live male births [3]. Two theories were suggested for development of hypospadias, endodermal theory and ectodermal theory [4]. Types of hypospadias are anterior, middle and posterior with the posterior type account approximately 20% of cases. Many surgical techniques were reported through history to correct this defect [3]. Patients with severe proximal defects and those with failed previous repairs (crippled hypospadias) often require difficult reconstructive procedures with relatively high complication rates [4]. Urethral reconstruction for primary and secondary hypospadias is best done using local penile and preputial tissues [5]. Infrequently, local tissue is inadequate to provide both skin cover and reconstruction of the neourethra. This is usually encountered after previous surgical failure has led to tissue loss and scarring and only rarely in cases of untreated severe hypospadias [6]. The use of buccal mucosa as urethral substitute material was first suggested by Humby in 1941 [7], and has been reintroduced by Burger, R A. and his group since in 1992 [8]. Various factors have contributed to the acknowledgement of buccal mucosal grafts (BMGs) as an ideal substitute for the urethra, including easy accessibility and manual handling, resistance to infection, compatibility with a wet environment, a thick epithelium and a thin lamina propria, allowing early inosculation and good medium-term results which are at least comparable with full-thickness skin grafts [9].