Oral mucosa graft for repair of hypospadias: outcomes at puberty.

Purpose: Oral mucosa graft has been used in the treatment of hypospadias for the last 15 years. We assessed the long-term outcome of oral mucosa grafts for urethral substitution in hypospadias surgery at our institution.

Materials And Methods: We retrospectively reviewed patients who underwent oral mucosa graft for hypospadias between 1994 and 2002. Data collected included indications, site of oral mucosa graft, complications and long-term outcomes. Followup information was obtained from the last clinical contact.

Results: A total of 37 patients underwent oral mucosa graft consisting of an onlay graft (30), urethral tube (5) or 2-stage Bracka type procedure (2). Of the patients 26 had undergone at least 1 previous operation for hypospadias. Following oral mucosa graft 10 patients had an early surgical complication requiring reoperation, including fistula (7), urethral stricture (2) and tortuous urethra (1). Three of the 5 patients (60%) with tubed grafts had complications. Long-term followup was available in 30 patients, of whom 28 are now postpubertal and 2 are peripubertal. One patient required redo urethroplasty for obstructive balanitis xerotica obliterans in the grafted urethra. Five patients have varying degrees of meatal stenosis, with only 2 requiring intervention to date.

Conclusions: Oral mucosa graft has a significant associated early complication rate of fistula and stricture, with 27% of cases requiring further surgery. However, the majority of oral mucosa grafts have stable urethral outcomes at puberty.