Bladder mucosa graft for construction of male urethra

A graft of bladder mucosa was used to construct the urethra in 35 males. Most were complicated hypospadias cases. In all patients there was insufficient prepucial or penile shaft skin available to use for making a substitute urethra. The bladder mucosa worked well in every case. There were no fistulas. There was no case with stenosis of the anastomosis between the graft and the patient's own urethral tissue. The one possible disadvantage encountered in using bladder mucosa was its tendency to become edematous and irritated if the graft was redundant at the meatus, a situation that is not encountered with grafts made from prepucial skin or skin taken from a remote area. Revision of the meatus was required in six patients. It is the experience of the authors that a free graft that is covered by two well vascularized layers, subcutaneous tissue, and skin, fares as well or better than a graft with a vascular pedicle.