Hipospadias ve üretra cerrahisinde mesane ve ağız mukozasının yeri

Abstract

SUMMARY Urethral repair is a serious problem in cases with large urethral defects or unsuccessfully operated patients. It is known that best results are obtained with pediculated penile skin flaps. However, if there is not any local penile skin or it is not sufficient enough for the repairment, the free grafts are useful. Various tissues ( ureter, saphenous vein, appendix, tunica vaginalis, skin graft etc. ) have been used for this purpose. Between these grafts, the free skin grafts have been used in hypospadias surgery for many years. Complications such as strictures and shrinkage, which may appear up to 30 percent in skin graft use, have caused the alternative graft material research studies to progress. Bladder mucosa and buccal mucosa are two of these graft materials. Between February 1991 and June 1995, 37 cases with urethral defect, in who pediculated penile skin flap could not be used, were repaired with bladder or buccal mucosal grafts. Bladder mucosa were used in 12 cases while 25 were repaired with buccal mucosa. The age of patients ranged among 6 and 24 year ( mean 21 year ). Follow up periods were noted as 30 to 48 months ( mean 42 ) for bladder mucosa cases and 1 to 36 months ( mean 20 ) for buccal mucosa cases. Our indications for operation consisted of cases with primary perineal hypospadias, cases with short urethra, unsuccessfully operated hypospadias patients, cases with anterior or posterior urethral strictures. We encountered 56 % minor complications ( single fistula, anastomotic stricture, meatal stricture ) and 8 % partial graft insufficiency in bladder mucosa cases while 56 % minor complication and 4 % total graft insufficiency in buccal mucosa cases. All minor complications were repaired easily under local anesthesia. When we evaluate our patients, bladder mucosa and especially buccal mucosa looks as an ideal treatment compared with free skin grafts in the patients whom either penile or prepucial skin is not available or sufficient. 47