ABSTRACT
Purpose: Buccal mnucosa graft used successfully to treat hypospadic patient with deficient penile skin. Tunica vaginalis flap proved its usefulness in repairing recurrent urethral fistula. We evaluate the results of combining both technques in management of penile hypospadias with insufficient senile skin. Patients and Between June 96 and June 99 we treated 25 hvpospadic patients, 3 circumcised and 22 redo cases, using buccal mucosa onlay graft. Hypospadcas was anterior penile in 6 and mid penile in 19 cases. Tunica vaginalis flap was used to cover the buccel graft in the last cases. Excellent functioal and cosmetic results were achieved in [56%] of cases following the operation. The success rate raised to [84%] after management of minor complications. Minor complications in 7 patients were in the form of minor fistula [16%], mild meatal retraction [4%], meatal stenosis [16%] and mild posterior stricture [8%]. Major complications were big fistula [8%] and complete failure of the procedure [8%]. No fistula occurred in cases in whom Tuncia vaginalis graft was used. Buccal mucosa onaly graft is a suitable material in hypospadias repair. Covering the graft with tunica vaginalis flap significantly decreases the incidence of fistula. Preservation of the uiethral plate decreases the size of grafting material