ABSTRACT
Background: Urethrocutaneous fistula is the most common complication of hypospadias surgery. Due to the poor surrounding tissue quality, surgical treatment of these patients represents a complex problem. Objectives: Present study aimed to determine a better procedure of salvage urethroplasty for failed hypospadias, caused by persistent large (>4mm) or multiple -small (<4mm) fistulae, by a randomized comparison.Methods: This interventional study was performed in a single institute over a period of five years. Comparisons were made among three procedures of salvage urethroplasty using substitution of dorsal skin flap, Flip flap, or buccal mucosal graft in a controlled situation. Outcomes were assessed by means of objective scoring system. Results: Refistula rate, devascularization of flap and grafts and wound dehiscence rate were significantly less in Buccal mucosal graft than flip flap and dorsal transposition flap. This led to a higher success rate and better patient compliance in buccal mucosal graft. Though mean duration of hospital stay was significantly longer in buccal mucosal graft compared to other methods, it did not negatively affect patient satisfaction due to overall higher success rate. The objective scoring evaluation revealed that score gain of BM group was significantly higher than that of dorsal transposition flap and flip flap. Conclusion: Staged redo urethroplasty for large or multiple-small fistulae using substitution of buccal mucosal graft revealed as an better option for urethral reconstruction than dorsal transposition flap and flip flap procedures (group A˃ group B ˃group C).