Child with multiple failed hypospadias surgeries Staged Buccal (oral) Graft Surgery repair with good success

AKM, 10-year-old boy with penoscrotal hypospadias, had undergone two stage hypospadias surgery at a hospital in Mumbai at age of 4 and 6 years. He developed difficulty in passing urine and had a lot of pain while passing urine. The urine stream was also narrow after hypospadias surgery. He came with fever and pus in urine. He had extreme pain while passing urine.

He was referred to Dr A.K.Singal, Pediatric Urologist and Hypospadias surgeon in emergency. We admitted the child at MITR hospital and started IV antibiotics as he had urinary infection. He was taken up for surgery two days later. The whole urethra was found to be narrow till bulbar urethra. We laid open the urethra till bulb of urethra deep in scrotum. The urethra from glans to penoscrotal region was excised. In the urethra from penoscrotal region to the bulb was augmented with a dorsal inlay oral mucosal graft taken from the cheek and primary closure was achieved till penoscrotal junction. Labial oral graft was harvested from the lip and whole ventral surface of penis was grafted with oral mucosa. The child was discharged two days later, and dressing and catheter was removed 7 days later. He did very well, and the graft healed well. Six months later, urethroplasty was completed from the penoscrotal junction till glans. Glansplasty was also done to complete the penile repair. Catheter was removed 6 months later. AKM has completed 4 years after surgery and now is passing urine well standing up like a normal boy and in good stream without any complications. The follow-up[ uroflowmetry studies have shown good outcome and good urine flow. The family is extremely happy to see good result in hands of expert surgeon.