Autologous saphenous vein graft as a urethral substitute for recurrent and proximal hypospadias

Introduction: Hypospadias is a congenital anomaly occurring in 0.3–5% of newly born males. Techniques for reconstructions of the urethra are: operations using local tissue flaps especially the prepuce or operations using distant flaps such as: skin, oral mucosa, bladder mucosa, intestinal mucosa, and tunica vaginalis or vein graft. The aim: The aim of this study is to evaluate the efficacy of autologous saphenous vein graft as a urethral substitute in recurrent and proximal hypospadias. Study design: This is a case series study which involved 11 patients (4–15) years old with recurrent or proximal hypospadias who presented to Mansoura university hospital during the period from January 2013 to September 2014. All patients underwent a vein graft as a urethral substitute. Results: The follow-up range: (6–19 months), with a median of 10.3 months. Complications developed in 4/11(36%). 1 case suffered from early postoperative penile hematoma, another patient developed early fistula and 2 cases developed meatal stenosis. Discussion: There are various urethral replacement by extra genital tissue which may be needed especially in circumcised infants and those with proximal or recurrent hypospadias. Veins used as urethral substitute usually are: saphenous, external jugular or the internal jugular because of their accessibility, available length and good caliber when compared with the urethral diameter. Although the study has the limitations of small number of cases and short follow up period we believe that it can pave the way for large multicenter studies which may give a new tool adding to our armamentarium in our struggle for the optimum cure for hypospadias especially recurrent and proximal case. Conclusion: autologous saphenous vein urethroplasty is a simple, safe, and effective procedure for hypospadias.