Long-Term Followup of Buccal Mucosa Onlay Graft for Hypospadias Repair: Analysis of Complications

PURPOSE: We review the long-term results of buccal mucosa onlay grafting for urethral reconstruction in hypospadias surgery in patients with followup of at least 5 years. MATERIALS AND METHODS: We retrospectively evaluated 132 patients who underwent buccal mucosa onlay graft for hypospadias repair, including 34 who underwent "salvage" grafting, during a 10-year period at our institution. In 49 cases with available followup longer than 5 years (average 6.2) complications were analyzed in detail. RESULTS: The overall complication rate was 24% (12 of 49 patients), with all but 3 complications occurring during the first postoperative year (3 fistulas, 1 stricture, 1 meatal stenosis, 2 graft contractures, 2 scars at oral harvesting site). The remaining 3 complications manifested during postoperative years 2 and 3, and encompassed 2 anastomotic strictures at the proximal anastomosis and 1 meatal stenosis. CONCLUSIONS: Buccal mucosa onlay grafts for urethral reconstruction in hypospadias repair seem to provide stable long-term results, with complications occurring primarily during the first 12 months postoperatively.