Background & Objectives: Hypospadiasis is a common congenital genitourinary malformation which has various surgical procedures for its reconstruction. Tabularized incised plate (TIP) is the most common technique and this study compares the use of BUCCAL MUCOSAL GRAFT combined to DOUBLE DARTOS FLAP WITH tunica vaginalis FLAP as second layers in TIP procedure.Material & Methods: In a prospective study 43 patients WITH hypospadiasis underwent TIP. Patients were randomly assigned into two groups. In the first group, 21 patients undergo BUCCAL MUCOSAL GRAFT combined to DOUBLE DARTOS FLAP and in the a second group, tunica vaginalis FLAP were used as second layer in 22 patients. Patients were followed and development of complications such as wound infections, meatal stenosis, and urethrocutaneous fistula formation were recorded. Failure was defined as need for repeated surgery.Results: The overall success rate was 87.5% (100% in first group and 60% in the second). 12 patients had complications (3 in the first group and 9 in the other group) which half of them needed surgical operation. In 5 patients of tunica vaginalis FLAP group developed urethrocutaneus fistula; nevertheless, no fistula was recorded in BUCCAL MUCOSAL GRAFT combined to DOUBLE DARTOS FLAP (P=0.048). Other complications were not significantly different in the 2 groups. The surgical success rate of patients undergoing BUCCAL MUCOSAL GRAFT combined to DOUBLE DARTOS FLAP was significantly higher than tunica vaginalis FLAP (P=0.021).Conclusion: BUCCAL MUCOSAL GRAFT combined to DOUBLE DARTOS FLAP as a second layer is a good technique WITH reasonable results in hypospadiasis surgery.

Recurrent oronasal fistula closure is a challenging phenomenon that has been managed WITH many surgical or FLAP techniques, such as local, regional, and distant FLAPs, WITH various modifications. Despite these options, the ideal method to repair this kind of chronic fistula has not yet been established. It is difficult to repair because recurrent surgical repairs or interventions cause this region to become more fibrotic WITH less vascular tissue, which considerably reduces the likelihood of closing this kind of fistula. For this reason, surgeons and researchers continue to work to overcome these obstacles by using more regional, vascular, and neighboring tissue. Classic cleft palate repair techniques use DOUBLE-layered, nasal, and oral side closure and even a three-layered technique (e.g. plus levator veli palatini and tensor veli palatini muscular repair) in the soft palate region. Hence, we used partial orbicularis oris muscle WITH enough vascular supply to repair the nasal side and cheek MUCOSAL FLAP to repair the oral side as a DOUBLE-layered repair technique. Two years later, during routine patient follow-up, no complications were identified, and the patient’s satisfaction WITH this treatment was acceptable.

Introduction: Our aim was to evaluate the efficacy of a tubed BUCCAL MUCOSAL GRAFT in repeat urethroplasty for patients WITH urethral stricture and failed previous operations.Materials and Methods: Ten patients (aged 12 to 47 years) WITH urethral stricture were entered into the study. All had a history of failed previous urethroplasties, and 5 had failed internal urethrotomies, too. Repeat urethroplasties were performed by excising the fibrous tissue around the stricture; BUCCAL mucosa was then harvested from the inner cheek, made into GRAFT tubing, and interposed into the defect. The patients were followed at 1, 6, and 12 months. Results: The procedure was technically successful in all the patients. The meanoperative time was 150 minutes. The stricture sites were in the posterior urethra in 8 and the anterior urethra in 2 patients. The mean urethral defect length was 4.9 cm. The primary etiology was pelvic fracture in 7 patients. Strictures recurred postoperatively in 3 patients, all of whom had a urethral defect longer than 5 cm, and 2 of whom had more than 1 previous failed urethroplasties (compared WITH lout of 7 in the successful cases). Urinary flow rate increased significantly (from 0 to 10.4 ± 7.33 mL/s) postoperatively (P = .018). Longer strictures produced significantly poorer GRAFT urethroplasty outcomes (P = .001).Conclusion: Urethroplasty WITH BUCCAL MUCOSAL GRAFTs is tough, resilient, easy to harvest, and leaves no scar. It appears to be an optimal substitute for anterior and posterior urethral strictures longer than 3 cm.

Introduction: Urethral reconstruction in complex hypospadias poses a significant challenge. We report our experience using BUCCAL mucosa to repair complex hypospadias.Materials and Methods: From February 2001 to September 2003, 16 urethral reconstructions were performed using BUCCAL MUCOSAL GRAFT. Twelve of the patients had previously failed urethroplasties, while the other 4 had perineal or scrotal hypospadias.GRAFTs were harvested from the lower lip. Onlay GRAFTs were used in 8 cases, and tubularized GRAFTs were used for the others.Results: after 14 to 27 months' follow-up, 11 of 16 (69%) patients developed complications, including meatal stenosis in 2 (12.5%), urethral stricture in 5 (31%), and urethrocutaneous fistula in 4 (25%). No oral complications were seen, and all of the urethroplasty complications were managed successfully.Conclusion: Urethroplasty using a BUCCAL MUCOSAL GRAFT may be accompanied by a relatively high complication rate, which is more common in patients WITH tabularized GRAFT; however, all complications can be managed successfully. We believe that urethroplasty using BUCCAL MUCOSAL GRAFT in complex hypospadias is an acceptable treatment modality.

Introduction: The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using BUCCAL MUCOSAL GRAFT in patients WITH a previous hypospadias repair.Materials and Methods: We reviewed records of our patients WITH urethrocutaneous fistula developed after hypospadias repair in whom BUCCAL MUCOSAL GRAFT fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination.Results: Fistula repair using BUCCAL mucosa patch GRAFT had been done in 14 children WITH urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 ± 1.99 years old (range, 4 to 11 years). Seven fistulas were in the midshaft, 4 were in the penoscrotal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients (78.6%). In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure.Conclusion: Our findings showed that fistula repair using BUCCAL MUCOSAL GRAFT can be one of the acceptable techniques for repairing fistulas developed after hypospadias repair. 

Background: Selection of a surgery method WITH best outcomes and least complications in hypospadias repair is of prime importance. Objective: To determine the advantages and disadvantages (complications) of Snodgrass procedure using vascularized DARTOS method in the repair of hypospadias. Methods: Through an interventional study, 31 patients WITH mid shaft to distal hypospadias were operated using Snodgrass method SUPPORTED WITH vascularized FLAP. All patients were operated once and by only one surgeon. Results of repairs were analyzed statistically. Findings: Out of 31 patients, 6 were under 3 years old, 19 between 3 to 7 years old and the rest were more than 7 years old. Results of hypospadias repair showed that there was no meatal stenosis & other complications except a fistula which was corrected surgically. Conclusion: Based on the data obtained from the present study, Snodgrass method using vascularized DARTOS FLAP for repair of hypospadias is strongly recommended.

Purpose: To compare BUCCAL Mucosa GRAFT WITH penile Skin FLAP techniques in the management of anterior urethral diffuse strictures longer than 3 cm. Materials and Methods: Thirty seven patients WITH a mean age of 28.5 (range 5 to 50) years had been treated by these two techniques using the ventral onlay patch from February 1997 to march 2002. Patients follow - up included physical examination, history taking, retrograde urethrography, cystoscopy and uroflowmetry at the month six, at the end of the first and the second years, and then yearly if required. These techniques were applied for anterior urethral strictures (bulbar and penile) longer than 3 cm. BUCCAL MUCOSAL GRAFT (BMG) was used in 18 patients and penile skin FLAP (PSF) in 19. Mean follow - up was 27.5 (range 6 to 50) months. Mean age was 30.8+11.8 years for BMG group and 27.8+15.6 years for PSF group. Urethral stricture etiology, surgery history, and previous endoscopic surgery history were similar in both groups. The stricture site in BMG group was penile in 2 patients (11.1%), bulbar in 8 patients (44.4%), and penobulbar in 8 patients (44.4%). In PSF group the stricture site was penile in 11 patients (57.9%), bulbar in 5 patients (26.3%) and penobulbar in 3 patients (15.8%). Success rate in 6 - month follow - up was 93.9% for BUG group and 83% for PSF. By performing dilatation and internal rethrotomy for mild strictures, the success rate WITH mean follow - up of 27.5 months was 13.8% for BMG group and 78.9% for PSF. Only one patients from BMG developed temporary impotence for about 12 months. Conclusion: BMG and PSF are considered as simple and proper techniques WITH good long term outcomes in the management of diffuse anterior urethral strictures. These 2 techniques could be applied in patients WITH history of several surgeries. The results of BMG were better than PSF, still, this difference was not statistically significant.

Nevus of Ota is a condition wherein the typical pattern of the bluish black pigmentation is noticed along WITH the cutaneous distribution of the trigeminal nerve. This condition is most prevalent in Japanese population but comparatively rare among Indians. We report a case of 23-year-old female presented WITH unilateral pigmented areas over the skin of forehead, malar area, ear and periorbital area.Blackish-blue pigmented areas were also noticed on the sclera. Brownish-black diffuse pigmented areas were also noticed on the BUCCAL mucosa of the same side. The presence of pigmentation on the skin over pinna and oral pigmentation made our case a rare incidence. Oral pigmentations associated WITH nevus of Ota especially on the BUCCAL mucosa have rarely been reported in the past.