R. ‘Buccal Mucosa Neourethras Grow Proportionally After Puberty’

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I read the excellent article published by Figueroa et al,1 and I think that in the future the real challenge for pediatric urologists will be the management of recurrent and residual curvature associated with proximal hypospadias.
It is clear that there are 2 choices of surgical procedures for failed hypospadias repair: the pedicle flap urethroplasty and the free grafts urethroplasty, and it is widely accepted that pedicle flaps are the best. The free grafts urethroplasty can only be proposed if it is impossible to have a pedicle flap. Among the substitution tissues, the oral mucosa grafts are the most commonly used. It is available in all patients, is easy to harvest, and is hairless. However, the buccal mucosa is now routinely used in urethral stricture repair, more rarely in hypospadias.
The penile skin, as the skin of the eyelid, is special; it does not resemble any other skin of the human body. It is more flexible and more extensible, and it is devoid of subcutaneous tissue, which gives it the ability to easily drag and considerably stretch during erection. In addition, the growth of the penis skin is dependent on androgens secretion. Thus, it is irreplaceable. The penis of the young child is small, and I think that there is always a solution for using penile skin, even for severe forms, provided that the treatment of hypospadias is entrusted to hypospadologists. The ideal solution in hypospadias repair would be to have a simple technique, which is easy to perform, can correct the deformity with few or no postoperative complications, and preserves the urogenital function of the penis.
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