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Use of Buccal Mucosa in Hypospadias Repair

  • Pediatric Urology (M Castellan and R Gosalbez, Section Editors)
  • Published:
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Abstract

Hypospadias is an embryological disorder that results in an abnormal ventral positioning of the urethral meatus. Among multiple surgical techniques described to correct this anomaly, the use of buccal mucosa grafts has gained popularity among pediatric urologists, pediatric surgeons and plastic surgeons. Buccal mucosa grafts have shown favorable histological changes that result in an excellent scaffold for urethral reconstructive surgery. This review describes the evolution of the use of buccal mucosa grafts in hypospadias repair.

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Abbreviations

BMG:

buccal mucosa graft

SIS:

small intestinal submucosa

BXO:

balanitis xerotica obliterans

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of great importance

  1. Fisch H, Lambert SM, Hensle TW, et al. Hypospadias rates in New York State are not increasing. J Urol. 2009;181(5):2291–4.

    Article  PubMed  Google Scholar 

  2. Huang WY, Chen YF, Guo YJ, et al. Epidemiology of hypospadias and treatment trends in Taiwan: a nationwide study. J Urol. 2011;185(4):1449.

    Article  PubMed  Google Scholar 

  3. Paulozzi LJ, Erickson JD, Jackson RJ. Hypospadias trend in two US surveillance systems. Pediatrics. 1997;100(5):831–4.

    Article  PubMed  CAS  Google Scholar 

  4. Gatti JM, Kirsch AJ, Troyer WA, et al. Increased incidence of hypospadias in small-for-gestational age infants in a neonatal intensive care unit. BJU Int. 2001;87(6):548–50.

    Article  PubMed  CAS  Google Scholar 

  5. Fredell L, Kochum I, Hansson E, et al. Heredity of hypospadias and the significance of low birth weight. J Urol. 2002;167(3):1423–7.

    Article  PubMed  Google Scholar 

  6. Fisch H, Golden RJ, Libersen GL, et al. Maternal age as a risk factor for hypospadias. J Urol. 2001;165(3):934–6.

    Article  PubMed  CAS  Google Scholar 

  7. Fisch H, Hyun G, Hensle TW. Rising hypospadias rates: disproving a myth. J Pediatr Urol. 2010;6(1):37–9.

    Article  PubMed  Google Scholar 

  8. Carmichael SL, Shaw GM, Nelson V, et al. Hypospadias in California: Trends and descriptive epidemiology. Epidemiology. 2003;14(6):701–6.

    Article  PubMed  Google Scholar 

  9. Manley CB, Epstein ES. Early hypospadias repair. J Urol. 1981;125(5):698.

    PubMed  CAS  Google Scholar 

  10. Duckett JW, Coplen D, Ewalt D, et al. Buccal mucosal urethral replacement. J Urol. 1995;153(5):1660–3.

    Article  PubMed  CAS  Google Scholar 

  11. Filipas D, Fisch M, Fichtner J, et al. The histology and immunohistochemistry of free buccal mucosa and full-skin grafts after exposure to urine. BJU Int. 1999;84(1):108–11.

    Article  PubMed  CAS  Google Scholar 

  12. •• Mokhless IA, Kader MA, Fahmy N, et al. The multistage use of buccal mucosa grafts for complex hypospadias: histological changes. J Urol. 2007;177(4):1496–9. The histological analysis of buccal mucosa grafts revealed epithelial hyperplasia, mild and focal keratinization resulting in good vascularization similar to that of the normal urothelium. These superior characteristics plus the ease of harvest, minimal contractility, and absence of hair make the buccal mucosa graft and invaluable tool for hypospadias repair.

    Article  PubMed  Google Scholar 

  13. Humby GA. A one-stage operation for hypospadias. Brit J Surg. 1941;29:84–92.

    Article  Google Scholar 

  14. Watanabe K, Ogawa A, Kiyono M. Reconstruction of the urethral meatus with buccal mucosal graft. Urol Int. 1995;55(1):29–31.

    Article  PubMed  CAS  Google Scholar 

  15. Payne CE, Sumfest JM, Deshon GE. Buccal mucosal graft for hypospadias repairs. Tech Urol. 1998;4(4):173–6.

    PubMed  CAS  Google Scholar 

  16. Wang HJ, Chiang PH, Lee FP, et al. Buccal mucosal graft for urethral reconstruction. J Formos Med Assoc. 2004;103(3):244–7.

    PubMed  Google Scholar 

  17. Bürger RA, Müller SC, el-Damanhoury H, et al. The buccal mucosal graft for urethral reconstruction: a preliminary report. J Urol. 1992;147(3):662–4.

    PubMed  Google Scholar 

  18. Dessanti A, Rigamonti W, Merulla V, et al. Autologous buccal mucosa graft for hypospadias repair: an initial report. J Urol. 1992;147(4):1083–4.

    Google Scholar 

  19. el-Kasaby AW, Fath-Alla M, Noweir AM, et al. The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol. 1993;149(2):276–8.

    PubMed  CAS  Google Scholar 

  20. Monfort G, Di Benedetto V, Meyrat BJ. Urethral stenosis in children:treatment using urethroplasty with a vesical or oral mucosal graft. Ann Urol. 1993;27(4):237–42.

    CAS  Google Scholar 

  21. Gonzálvez Piñera J, Pérez Martínez A, Andújar Cairo M, et al. Buccal mucosa graft for severe hypospadias repair. Cir Pediatr. 1994;7(1):48–9.

    PubMed  Google Scholar 

  22. •• Bracka A. Hypospadia repair: the two-stage alternative. BJU Int. 1995;76(3):31–41. As opposed to previous studies describing the use of buccal mucosa graft in single staged hypospadias repair, Bracka described his experience with 600 patients using a two-stage approach. With a follow-up that ranged up to 10 years, the author demonstrated the excellent functional and cosmetic results obtained by using buccal mucosa graft.

    Google Scholar 

  23. Snodgrass W, Elmore J. Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol. 2004;172(4):1720–4.

    Article  PubMed  Google Scholar 

  24. Leslie B, Lorenzo AJ, Figueroa V, et al. Critical outcome analysis of staged buccal mucosa graft urethroplasty for prior failed hypospadias repair in children. J Urol. 2011;185(3):1077–82.

    Article  PubMed  Google Scholar 

  25. Morey AF, McAninch JW. When and how to use buccal mucosa grafts in adult bulbar urethroplasty. Urology. 1996;48(2):194–8.

    Article  PubMed  CAS  Google Scholar 

  26. Ahmed S, Gough DC. Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol. 1997;80(2):328–30.

    Article  PubMed  CAS  Google Scholar 

  27. Barbagli G, Selli C, Tosto A, et al. Dorsal free graft urethroplasty. J Urol. 1996;155(1):123–6.

    Article  PubMed  CAS  Google Scholar 

  28. Barbagli G, Palminteri E, Lazzeri M. Dorsal onlay techniques for urethroplasty. Urol Clin North Am. 2002;29(2):389–95.

    Article  PubMed  Google Scholar 

  29. Wessels H. Ventral onlay graft techniques for urethroplasty. Urol Clin North Am. 2002;29(2):381–7.

    Article  Google Scholar 

  30. Elliot SP, Metro MJ, McAninch JW. Long-term followup of the ventrally placed buccal mucosa onlay graft in bulbar urethral reconstruction. J Urol. 2003;169(5):1754–7.

    Article  Google Scholar 

  31. Fichtner J, Filipas D, Fisch M, et al. Long-term outcome of ventral mucosa onlay graft urethroplasty for urethral stricture repair. Urology. 2004;64(4):648–50.

    Article  PubMed  Google Scholar 

  32. Palminteri E, Mazon G, Berdondini E, et al. Combined dorsal plus ventral double mucosa graft in bulbar urethral reconstruction. Eur Urol. 2008;53(1):81–9.

    Article  PubMed  Google Scholar 

  33. Palminteri E, Berdondini E, Shokeir AA, et al. Two-sided bulbar urethroplasty using dorsal plus ventral oral graft: urinary and sexual outcomes of a new technique. J Urol. 2011;185(5):1766–71.

    Article  PubMed  Google Scholar 

  34. Asopa HS, Garg M, Singhal GG, et al. Dorsal free graft urethroplasty for urethral stricture by ventral sagittal urethrotomy approach. Urology. 2001;58(5):657–9.

    Article  PubMed  CAS  Google Scholar 

  35. • Hayes MC, Malone PS. The use of dorsal buccal mucosal graft with urethral plate incision (Snodgrass) for hypospadias salvage. BJU Int. 1999;83(4):508–9. Failed hypospadias surgery presents a challenge to reconstructive surgeons. The use of the “Snodgraft” technique had been successfully used in these complex hypospadias cases.

    Article  PubMed  CAS  Google Scholar 

  36. Snodgrass W. Tubularized, incise plate urethroplasty for distal hypospadias. J Urol. 1994;151(2):464–5.

    PubMed  CAS  Google Scholar 

  37. Gundeti M, Queteishat A, Desai D, et al. Use of an inner preputial free graft to extend the indications of Snodgrass hypospadias repair (Snodgraft). J Pediatric Urol. 2005;1(6):395–6.

    Article  CAS  Google Scholar 

  38. Macedo A, Liguori R, Garrone G, et al. One-stage complex hypospadia repair combining buccal mucosal graft, preputial flap and tunical vaginalis flap (the three-in-one technique). J Pediatr Urol. 2011;7(1):76.e1-2.

    Article  PubMed  Google Scholar 

  39. Macedo A, Liguori R, Ottoni SL, et al. Long-term results with a one-stage complexy primary hypospadias repair strategy (the three-in-one technique). J Pediatr Urol. 2011;7(3):299–304.

    Article  PubMed  Google Scholar 

  40. •• Snodgrass WT, Bush N, Cost N. Algorithm for Comprehensive Approach to Hypospadias Reoperation Using 3 Techniques. J Urol. 2009;182(6):2885–91. The prospective study demonstrates the excellent outcomes that may be obtained in cases of previous failed hypospadias repair. Although the technique used will ultimately be surgeon’s preference, this algorithm provides a guide to reconstructive surgeons in hypospadias reoperation.

    Article  PubMed  Google Scholar 

  41. Rourke K, McKinnny S, St. Martin B. Effect of wound closure on buccal mucosal graft harvest site morbidity: Results of a randomized prospective trial. Urology. 2012;79(2):443–8.

    Article  PubMed  Google Scholar 

  42. Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: A pilot study. J Urol. 2006;175(2):589–92.

    Article  PubMed  Google Scholar 

  43. Maarouf AA, Elsayed ER, Ragab A, et al. Buccal versus lingual mucosal graft urethroplasty for complex hypospadias repair. J Pediatric Urol. 2012. doi:10.1016/j.jpurol.2012.08.013.

    Google Scholar 

  44. Palminteri E, Berdondini E, Maruccia S, et al. Preliminary results on the use of autologous cell culture grafts in buccal mucosa in urethra repairs. Urologia. 2012. doi:10.5301/RU.2012.9377.

    PubMed  Google Scholar 

  45. Markiewicz M, Lukose M, Margarone J, et al. The oral mucosa graft: A systemic review. J Urol. 2007;178(2):387–94.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Dr. Omar Cruz-Diaz reported no potential conflicts of interest relevant to this article.

Dr. Miguel Castellan is a section editor for Current Urology Reports.

Dr. Rafael Gosalbez is a section editor for Current Urology Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Omar Cruz-Diaz.

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Cruz-Diaz, O., Castellan, M. & Gosalbez, R. Use of Buccal Mucosa in Hypospadias Repair. Curr Urol Rep 14, 366–372 (2013). https://doi.org/10.1007/s11934-013-0334-9

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  • DOI: https://doi.org/10.1007/s11934-013-0334-9

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