Bracka's Method of Proximal Hypospadias Repair: Preputial Skin or Buccal Mucosa?

Urology. 2020 Apr:138:138-143. doi: 10.1016/j.urology.2019.12.027. Epub 2019 Dec 31.


Objective: To analyze treatment results of staged surgical repair of proximal forms of hypospadias according to Bracka's technique using preputial vs buccal grafts.

Material and methods: We retrospectively reviewed 220 patients with proximal forms of hypospadias treated with Bracka's urethroplasty technique. They were divided into 2 groups: Group I-108 patients treated with preputial skin grafts in 2001-2013; Group II-112 patients who underwent urethroplasty with buccal mucosa grafts in 2013-2016.

Results and discussion: Of the Group I patients with preputial skin grafts, complications were obtained in 33 (31%) cases; in Group II-23 (20%) cases. Complications include fistulas, defects of urethra, and scar contraction of grafts. The cosmetic results according to Hypospadias Objective Penile Evaluation scale were more satisfactory when buccal mucosa grafts were used. Further studies are needed to analyze the long-term changes posturethroplasty with both preputial skin and buccal mucosa grafts.

Conclusion: This is one of the only studies to compare complications and histology of the 2 free grafts: preputial skin and buccal mucosa. This study affirms that a staged surgical method with the use of free grafts according to Bracka's technique is a successful method of treatment of proximal forms of hypospadias in children achieving good functional and cosmetic results with a relatively low rate of complications.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Foreskin / transplantation
  • Free Tissue Flaps / adverse effects
  • Free Tissue Flaps / transplantation*
  • Humans
  • Hypospadias / surgery*
  • Infant
  • Male
  • Mouth Mucosa / transplantation
  • Plastic Surgery Procedures / adverse effects
  • Plastic Surgery Procedures / methods*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Treatment Outcome
  • Urethra / abnormalities
  • Urethra / surgery
  • Urologic Surgical Procedures, Male / adverse effects
  • Urologic Surgical Procedures, Male / methods*