Abstract

BACKGROUND:
Proximal hypospadias is a challenging case for the urologist due to the complexity of this type of hypospadias.  Many surgeons adopting two stage repair for better cosmetic and functional results. The choice of the best graft to take for the repair remains controversial. Thus we are comparing buccal versus preputial grafts for post-operative surgical and histological outcomes.
OBJECTIVE:
To compare the surgical and histological outcome of inner preputial and oral mucosal grafts when used in two-stage proximal hypospadias repair.
METHODS:
Eighteen patients underwent two-stage graft hypospadias repair: first stage, urethral plate transection, graft harvesting and placement done. They were divided into two groups; group A, oral mucosal graft group; group B, inner preputial graft group. Second stage, urethroplasty and glansplasty were done. Patients followed up for 6 months postoperatively after each stage.
RESULTS:
Eighteen patients were included. First stage: group A (8 patients) with mean age 9.7 years, 6 primary and 2 redo cases. The mean operating time was 199 minutes. Group B (10 patients) with mean age 7.4 years, 9 primary and 1 redo case. The mean operating time was 179 minutes (significant statistical difference). The graft take was successful in all cases. None had significant postoperative complication or graft contracture.
Second stage: The mean time to perform second stage was 6.7 months. The second stage was event free in 75% of patients in group A while 12.5% had distal glans dehiscence and 12.5% had small distal fistula. Group B had 80% event free while 20% of patients had distal glans dehiscence (no significant statistical difference).
Histological examination showed good vascularization and minimal fibrosis in both graft types.
CONCLUSION:
The use of these graft types had excellent outcomes in terms of graft take and event free rates and  the choice of graft governed by surgeon preference, patient preference and the state of prepuce.