Urethroplasty - Substitution Urethroplasty

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The indications are:

  1. urethral plate too bad or absent e.g. Hypospadius cripple
  2. Necrosed or stenosed bulbar urethra.


Hyposdius cripple – these patients have multiple failed hypospadius repairs. They are left with minimal local skin for repair and have multiple strictures and or fistulae in the urethra. They are best dealt with two stage BMG urethroplasty. In the first stage the whole bad urethra is excised with all the scar tissue the penis made straight and its position is checked by intra cavernosal injection of saline. A 2.5cm wide graft of buccal mucosa or two strips of 1.5cm wide buccal mucosa graft are spread and fixed over the corpora cavernosa. The graft is quilted with absorbable sutures. The second stage is performed 3-6 months later. A U incision is made and the buccal mucosa is turned into a tube a 14 F silastic Foley catheter is inserted and the skin is closed with Z plasties.