Reconstruction of Hypospadias and Epispadias with Buccal Mucosa Free Graft as Primary Surgery: More than 10 Years of Experience

PURPOSE: The most common techniques to reconstruct the urethra for severe hypospadias or epispadias involve use of the genital skin. Buccal mucosa free graft is usually used in a second operation due to a paucity of usable genital tissue. We report our experience using buccal mucosa free graft as primary surgery for hypospadias and epispadias. MATERIALS AND METHODS: Between 1989 and 2001 the urethra was reconstructed using buccal mucosa free graft as a primary operation in 22 patients 3 to 13 years old with middle or proximal hypospadias (20) and exstrophy/epispadias (2). In the first 5 cases of hypospadias the buccal mucosa was combined with bladder mucosa. In the 2 exstrophy/epispadias cases treated with the penile disassembly technique the distal part of the urethra was reconstructed with buccal mucosa. RESULTS: At mean 5-year followup 2 cases of urethral fistulas and 1 case of severe stenosis of the proximal anastomosis were observed, which required surgical correction. In 4 other cases mild stenosis of the anastomosis required urethral dilations in the first month after surgery. CONCLUSIONS: Buccal mucosa is an excellent source of graft material for urethral replacement in complex urethroplasties as primary surgery. It is readily available, elastic, resistant and technically easy to harvest.