Buccal mucosa graft for simultaneous correction of severe chordee and urethroplasty as a one-stage repair of scrotal hypospadias (watch technique)

  • Miroslav L. DjordjevicEmail author
  • Marta Bizic
  • Borko Stojanovic
  • Marko Bencic
  • Vladimir Kojovic
  • Gradimir Korac
Topic Paper



Severe hypospadias repair still presents a great challenge. We evaluated a novel approach of using a specially shaped buccal mucosa graft for simultaneous ventral tunica grafting and new urethral plate creation, in combination with longitudinal dorsal island skin flap, as a one-stage repair of severe hypospadias.


Between July 2014 and September 2017, 26 patients (aged from 12 to 22 months) underwent scrotal hypospadias repair. Short and non-elastic urethral plate is divided. Buccal mucosa graft is harvested from the inner cheek, and designed in a special “watch” shape, with the spherical part in the middle and two rectangular parts on both sides. Tunica albuginea is opened ventrally for penile straightening and grafted to the spherical part of the “watch-shaped” buccal mucosa with 6–8 “U-shape” stitches. The rectangular parts are fixed to the tip of the glans distally and native urethral meatus proximally. Longitudinal dorsal skin flap is harvested, button-holed ventrally and joined with buccal graft. Penile skin reconstruction is performed using available penile skin.


The mean follow-up was 22 months (range from 9 to 46 months). Satisfactory results were achieved in 22 patients. Two urethral fistulas were successfully repaired by minor surgery after 3 months, while one meatal stenosis and one urethral diverticulum were successfully treated by temporary urethral dilation. There were no cases of residual curvature.


Specially shaped buccal mucosa graft for simultaneous curvature correction and urethroplasty could be a good choice for single-stage repair of scrotal hypospadias with severe curvature.


Penis Scrotal hypospadias Penile curvature Buccal mucosa graft Watch-shaped graft Urethroplasty 



This paper is supported by Ministry of Science and Technical Development, Republic of Serbia, Project no. 175048.

Author contributions

DML: project development, data collection, and manuscript writing. BM: data collection and analysis. SB: data collection and manuscript editing. BM: data analysis. KV: manuscript editing. KG: project development.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Formal consent

For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants (parents or legal guardians) included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of MedicineUniversity of BelgradeBelgradeSerbia
  2. 2.Department of UrologyUniversity Children’s HospitalBelgradeSerbia

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