Oral Mucosa Graft for Repair of Hypospadias: Outcomes at Puberty

PurposeOral 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 MethodsWe 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.ResultsA 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.ConclusionsOral 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.