A 27 year old male patient presented with a history of recurrent urethral stricture and incontinence. He had symptoms of intermittency, slow stream , dysuria and incontinence more than ten years. He had a two times hypospadias repair, one with scrotal skin flap, in the past. He didn’t have any comorbidities and he was not on any medications. He underwent right orchiopexy and ear operations in childhood. The physical examination demonstrated two fistulas at urethra. Urinalysis and creatinine levels were within normal limits. Maximum flow rate was found 10 ml/min (after fistulas closed by finger) and post-void residual urine was not determined. Uretral stricture and kontrast agent leaking observed in urethrography. At the time of urethroscopy we determined two fistulas mouth and hairy skrotal flap tissue on anterior urethra. Patient underwent double buccal mucosa graft urethroplasty after fistula and hairy urethral tissue excision.

This video presentation shows the details and surgical steps of the operation.

The patient was successfully treated with this surgery. Peroperative and postoperative complications was not observed. The patient was discharged three days after surgery. After three weeks urethral catheter was removed. Maximum flow rate was found 21 ml/min and post void residual urine was not determined.

Management of failed hypospadias repair requires complex and diffcult procedures. A study has shown that 9% secondary surgery rate for distal hypospadias repair and 32.2% for proximal hypospadias repairs (1).Using grafts or flaps as well as buccal mucosa improves success of reconstructive management. Using skin flaps are easy but have some disadvantages like our patient. Currently buccal mucosa grafts  are highly used for urehral stricture treatment. 

In the literature there are one stage and two stage repair techniques. In our case we successfully performed double buccal mucosa graft urethroplasty after fistula and hairy urethral tissue excision at one stage.

Lee O.T., Durbin-Johnson B., Kurzrock E.A. Predictors of secondary surgery after hypospadias repair; a population based analysis of 5000 patients. J Urol. 2013;190:251–255