Urethral substitution using vein graft for hypospadias repair.

OBJECTIVE Complex hypospadias surgery requires abundant and stretchable tissues for urethroplasty. Genital skin is ideal for this purpose but is often unavailable in re-do cases. Extragenital tissues have their drawbacks such as the limited length of buccal and bladder mucosa, and contracture of skin grafts. Tubularization and on-lay techniques comprise one or two longitudinal suture lines that are the source of complications. We investigate the possibility of using a saphenous vein graft to construct a long, wide, stretchable and pre-tubularized neourethra that is not compromised by the longitudinal suture line. PATIENT AND METHOD A male patient with proximal hypospadias for which surgical correction had failed underwent the operation. The patient had a penoscrotal meatus and was circumcised. A saphenous vein graft was passed through a tunnel created on the ventral aspect of the penis, and was anastomosed to the urethra proximally and the distal opening of the tunnel at the tip of the penis. RESULTS After 12 months, the patient had a forward stream, no dilatation of the neourethra, and no penile curvature upon morning erection (as reported by the parents). CONCLUSION This initial experience with saphenous vein urethroplasty shows that the technique is feasible, and may provide a reliable and practical alternative to the current techniques.