Combined Buccal Mucosa Graft (Watch Shape) with Onlay Skin Flap for Severe Hypospadias: One-Stage Repair

Abstract

Severe hypospadias repair includes one-stage or two-stage reconstruction, depending on several hypospadiac parameters as well as surgeon’s preference. Penile and glans size, degree of curvature, urethral plate development, and availability of penile skin dictate the surgical approach. One-stage procedures have the advantage of correcting all deformities and complete reconstruction in one surgery, where possible. We previously published technique using buccal mucosa graft combined with longitudinal island skin flap for one-stage severe hypospadias repair. However, in most severe cases transection of urethral plate does not lead to complete penile straightening. In those cases, additional correction of curvature is required. Mobilization of neurovascular bundle would compromise glans vascularization, and dorsal plication would additionally shorten the penis. That is why ventral grafting presents more suitable option, as a lengthening procedure. There are several options for grafting material, and we presumed that buccal mucosa graft could be specially fashioned to be used for grafting, and simultaneously for urethral plate creation as well, in selected cases. Urethroplasty is finalized with previously described dorsal longitudinal island skin flap, button-holed on the ventral side. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.