[Scrotal hypospadias. Our experience with free oral mucosa grafts]

Many surgical techniques, using different tissues, have been performed to repair the scrotal hypospadias in this century, but none of them has been completely effective. The use of autologous buccal mucosa as a free graft for urethral replacement was introduced in 1989. The reported results have been encouraged since then. Twenty three patients with scrotal hypospadias, have been treated from 1991 to 1998. These patients underwent a 2-stage surgical replacement. The first stage of the procedure included correction of the penile curvature and advancement of preputial flaps ventrally as described by Byras. The second stage of the procedure was the urethroplasty. The neourethra was made of a tubularized buccal mucosa graft. The mucosa was harvested from the inner surface of the lower lip. The first stage was performed at a mean age of 20 months old, and the second stage at a mean age of 32 months old. Micropenis was detected in 26% of patients. All of them were treated with topic testosterone before the second stage. The follow-up reflected that 7 out of 23 patients (30.4%) had not complications, while 16 patients (69.5%) developed urethro-cutaneous fistula. Six of them (26%) required only one surgical closure and the other 10 patients required more than one surgical procedure to correct several complications. One patient presented complications in both the recipient and the donor areas. Nowadays, cosmetic and functional results are good in 22 patients.