Eur J Pediatr Surg 2008; 18(6): 427-430
DOI: 10.1055/s-2008-1038929
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

One-Stage Repair of Severe Hypospadias Using Combined Buccal Mucosa Graft and Longitudinal Dorsal Skin Flap

M. L. Djordjevic1 , M. Majstorovic1 , D. Stanojevic1 , M. Bizic1 , S. Ducic1 , V. Kojovic1 , V. Vukadinovic1 , G. Korac1 , S. Perovic1
  • 1Department of Urology, School of Medicine, University of Belgrade, Belgrade, Serbia
Further Information

Publication History

received June 23, 2008

accepted after revision July 7, 2008

Publication Date:
27 November 2008 (online)


Aim of the Study: Urethral reconstruction in severe hypospadias presents a great challenge. We evaluated a method of combining longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in the most severe hypospadias. Our aim was to repair the most difficult cases in a one-stage procedure. Methods: Between January 2003 and July 2007, 23 patients (aged from 9 to 26 months) underwent repair of severe hypospadias (18 penoscrotal and 5 scrotal forms). The short urethral plate is divided in all cases and the remaining curvature was repaired by dorsal plication. The buccal mucosa graft is harvested and fixed to the ventral side of corpora cavernosa to form the first half of the neourethra. A longitudinal dorsal island skin flap is created and buttonholed ventrally. It is sutured to the buccal mucosa graft to form the neourethra. An abundant flap pedicle is fixed laterally to cover all the suture lines of the neourethra. Penile skin reconstruction is done using available penile skin. Results: The mean follow-up was 27 (range 11–66) months. Satisfactory results were achieved in 20 patients. There were two urethral fistula and one temporary distal urethral stricture. Conclusion: A combined longitudinal island skin flap and buccal mucosa graft could be a good choice for single-stage urethral reconstruction in the repair of the most severe hypospadias.


M.D., Ph.D. Miroslav L. Djordjevic

Associate Professor of Surgery/Urology
Department of Urology
University Children's Hospital

Tirsova 10

Belgrade 11000