Tubed free skin graft for construction of male urethra

A tubed, free skin graft was used to construct a urethra in 49 young male subjects. Indications included 1) multiple previous hypospadias operations, 2) new severe hypospadias cases, 3) chordee without hypospadias but with a short urethra, 4) epispadias, 5) distal urethral stricture and 6) a small number of patients undergoing an initial operation for hypospadias by the Horton-Devine technique. No fistulas or leaks occurred. The over-all complication rate was low. Based on our own experience and that reported by others we believe that a free tubed graft is an excellent method for making a substitute urethra in a variety of urethral problems in children and young adults. It is important that the graft is of full or nearly full thickness because thin grafts tend to contract.