ArticleTranslational andrology and urology2026
Perineal approach with penile invagination for one-stage oral mucosa graft urethroplasty in adults with hypospadias-associated strictures.
Article in Translational andrology and urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Urethral strictures in adults with a history of childhood hypospadias repair represent a complex reconstructive challenge due to altered anatomy, deficient spongiosum, and frequent use of penile skin in prior repairs. The aim of this study was to prospectively evaluate the anatomical, functional, and patient-reported outcomes of single-stage oral mucosa graft (OMG) urethroplasty performed through a perineal approach with penile invagination in adults with hypospadias-associated urethral strictures. Methods: This prospective, single-center study included adult patients undergoing single-stage dorsal onlay OMG urethroplasty via a perineal approach with penile invagination (2022-2024). Outcomes were assessed using objective measures (urethral caliber and uroflowmetry) and urethral stricture surgery-patient-reported outcome measures (USS-PROMs). Anatomical success was defined as the ability to pass a 16 Fr catheter without resistance and no need for secondary urethral procedures. Functional success was defined as maximum urinary flow rate (Qmax) >12 mL/s. Complications were graded according to Clavien-Dindo. Results: Eleven patients were included. Median age was 54 [interquartile range (IQR), 45-64] years and median follow-up was 16 (IQR, 13-25) months. Median stricture length was 6 (IQR, 5-7) cm. Meatal location was glanular or subcoronal in most patients, with one mid-shaft meatus; no concomitant meatal reconstruction was performed. Median urethral caliber improved from 5 (IQR, 4-6) to 16 (IQR, 12-16) Charriere (Ch), and median maximum urinary flow rate (Qmax) from 6 (IQR, 4-8) to 16 (IQR, 12-19) mL/s. Anatomical success was achieved in 6/11 patients (55%), whereas functional success was observed in 10/11 (91%). Median USS-PROM symptom score improved from 17 (IQR, 16-18) to 3 (IQR, 2-5). Four patients (36%) developed penile hematoma, two with associated wound dehiscence; all were managed conservatively (Clavien-Dindo I). No urethrocutaneous fistula occurred. Conclusions: Single-stage dorsal onlay OMG urethroplasty using a perineal penile invagination approach provides high functional improvement and patient satisfaction in selected adults with hypospadias-associated strictures, while avoiding penile incision and with a low rate of clinically relevant complications.
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