The durability and easiness of suturing and harvesting may be explained by high elastin in the buccal mucosa. However, the buccal mucosa basement tissue has an elastin-rich connective tissue which is stiff and can provide a good scaffolding preventing a diffuse diverticulum.
There are several tissues that can be harvested easily from the inner cheeks: harvesting two strips (one from each cheek) if there is a need for a long strip, and Harvesting long graft of the buccal mucosa (from inner cheek to lower lip) may result in scarring and deformity of mouth angle.
#Attachment tamer replacement skin#
The typical two-staged technique includes first, penile curvature correction with ventral bed of tissue preparation (buccal mucosa, preputial skin grafts, or transposed flaps of prepuce), and second, the neourethral plate is tubularized. Therefore, techniques of Yoke for repairing hypospadias are deemed a secure and efficient technique for repairing severe proximal hypospadias owing to the continuity of skin flap of the prepuce and ventral urethral plate with vascular pedicle blood supply. It is the recommended technique despite its high rate of reoperativity, as it contributes to a pleasant cosmetic outcome while also minimizing the average operations’ number most children would need. Preoperatively, one of the essential prerequisites is the hormonal stimulation. In severe hypospadias, modified Koyanagi (MK) repair is a two-staged repair done in one setting and had an extra-benefit of associated transposition correction. There are many techniques (ranging from single-stage ‘tubes’ to staged repairs), as most techniques have no good outcome. Penoscrotal transposition occurs in few cases. In 10–20% of all hypospadias, proximal hypospadias with chordee occur with their complex nature. Two-staged urethroplasty is a technically straightforward and feasible technique, with less fistula rate, but requires more time, as a two-session operation, with good results in severe chordee and success rate. The MK for repair of proximal hypospadias is a good technique and gives successful surgical results but requires meticulous technique and tedious preservation of blood supply. Higher incidence of fistula was in group A (six cases) than group B (two cases), urethral stricture was the same (two cases in each group), meatal stenosis was less in group A (two cases) than group B (eight cases), and residual chordee was more in group A (two) than B (one), with no penile rotation in both groups. The rate of success was 60% in group A compared with 75% in group B.
The follow-up ranged from 6 to 18 months. Patients were randomized into two equal groups ( n=20): group A underwent MK technique, and group B underwent two-staged urethroplasty using buccal mucosal graft techniques. Patients and methodsĪ total of 40 patients with proximal hypospadias types were enrolled, and these patients underwent surgical repair using MK technique or two-stage urethroplasty using buccal mucosal graft techniques. The purpose of our study is to compare the modified Koyanagi (MK) technique and two-staged urethroplasty by buccal mucosal graft techniques in managing proximal hypospadias types regarding rate of success, postoperative complications, and cosmesis. There are many techniques used, but no technique has shown success or acceptance universally.
One of the most challenging cases in correction is proximal hypospadias.
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