Objective To explore the clinical efficacy of oral mucosal free graft in urethroplasty for various types of hypospadias. Methods Oral mucosal free grafts were transplanted and sutured to the ventral surface of penile tunica albuginea. Using the graft as a part of reconstructed urethra could provide a clinical solution for various problems, such as poor development of urethra plate, urinary tract defect after penile curative correction, lacking of alternative surgery materials and etc. In this study, the technique of longitudinal urethral plate incision was in combination with the methods of urethral reconstruction by inlay oral mucosal graft and one-stage transverse preputial island flap urethral reconstruction with coupled urethroplasty. Results In 60 cases of patients received urethroplasty for various types of hypospadias, all the oral mucosal grafts survived and formed an important constituent of the reconstructed urethra. The penile appearances were all satisfactory, urinary fistula presented in only 5 cases, which were all successfully fixed half a year after fistula repairs. Metastatic flap necrosis occurred in 2 cases, which were all spontaneously healed after changing the dressings. Urethral stricture occurred in 3 cases, which were all cured after receiving periodic urethral dilation, the success rate of about 80% . Conclusions The application of oral mucosal free grafts in urethroplasty for hypospadias features a number of advantages, including easy material recovery , high survival rate, high mucosal thickness, high elasticity and etc. The incidences of post-operative urethral stricture and urinary fistula are relatively lower, and thus this graft could be applied to the urethroplasty procedures for various types of hypospadias.%目的 探讨游离移植物口腔粘膜在各型尿道下裂中尿道重建的应用效果.方法 将游离移植物口腔粘膜移植于阴茎腹侧白膜表面,固定.成为重建尿道一部分,以弥补尿道板的发育欠佳及阴茎弯曲纠正后尿道缺损过长、再次手术材料缺乏等,并综合应用尿道板纵形切开,镶嵌口腔粘膜尿道重建及转移带蒂皮瓣“加盖”方式重建尿道-耦合法尿道成形术.结果 60例各型尿道下裂成形术,口腔粘膜移植物均存活,成为重建尿道的重要组成部分.阴茎外形满意,有5例发生尿瘘,术后半年均行尿瘘修补术成功.2例转移皮瓣坏死,换药后愈合.3例尿道狭窄予以定期尿道扩张后治愈,成功率约80％.结论 口腔粘膜游离移植物应用于尿道下裂尿道重建有取材方便、易于存活、粘膜厚、弹性好等特点.术后发生尿道狭窄,尿瘘机率小,且适用于各型尿道下裂的尿道重建.
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