Split-thickness skin graft urethroplasty and tunica vaginalis flaps for failed hypospadias repairs

Purpose: Via a 2-stage procedure, 10 patients with failed hypospadias repairs were treated by a varied combination of split-thickness mesh graft urethroplasty and tunica vaginalis flap. Materials and Methods: A bed for the mesh graft in 3 patients was provided by a tunica vaginalis flap. Tunica vaginalis flaps were also used as an intermediate layer during stage 2 of the repair. Results: No strictures or fistulas occurred in 8 patients. Two patients await stage 2 repair after successful stage 1 placement of the mesh graft. Conclusions: The combination of split-thickness mesh graft urethroplasty and a tunica vaginalis flap appears to achieve success in the difficult patient with complex hypospadias subsequent to multiple failed repairs.