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Two-Stage Repair for Severe Proximal Hypospadias Using Oral Mucosal Grafts

Combination of a Modified Bracka Method and a Modified Byars Flap Method

Mitsukawa, Nobuyuki MD*; Saiga, Atsuomi MD; Akita, Shinsuke MD*; Kubota, Yoshitaka MD*; Kuriyama, Motone MD; Satoh, Kaneshige MD*

doi: 10.1097/SAP.0b013e318292099d
Reconstructive Surgery
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One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method.

From the *Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Chiba; †Department of Plastic and Reconstructive Surgery, St. Mary’s Hospital, Fukuoka; and ‡Department of Plastic Surgery, Kochi Medical School Hospital, Kochi, Japan.

Received January 15, 2013, and accepted for publication, after revision, March 12, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Nobuyuki Mitsukawa, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. E-mail: nmitsu@air.linkclub.or.jp.

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