Children with previous repair of hypospadias by skin graft will continue to suffer at adulthood from hairy and short urethra and penile bending during erection.
What is the best technique to resolve such problem
By hypospadias cripple, we mean a patient with insufficient suitable local tissue(prepuce, penile skin, urethral plate) for urethroplasty. The insufficiency stems from the complications of previous repairs.
In such cases, a two-staged Bracka repair using buccal mucosa graft gives very satisfactory results. However, the harvesting and grafting of an adequately large buccal mucosa patch needs skill and experience. One needs to observe the technique in the hands of someone skilled in performing it, before embarking upon doing it for the first time.
There is no single answer to this question. The solution of this difficult problem will be changed according to each surgeon's knowledge and experience.
I agree that there is no single answer to your question. This depends on the previous repair(s) specificities and on the problem that the patient presents. Generally speaking, Bracka technique will be useful to reconstruct cases with a useless/absent urethra/uretral plate. In My experience, the most Severe AND common problems are recorrent curvature (associated to absent or short urethra), where Bracka grafts are useful, buried AND scarred penises (to be tratei with techniques used for inconspicuous
the success of hypospadias repair, not include the tip sited meatus with fair stream, it extended to ivolve the free rate of other complications.
Regarding this case you may revise the procedure, by removing the skin and placement of buccal graft.
Staged hypospadias repair with buccal graft and aggressive management of residual Chordee ... please also read our article; https://www.frontiersin.org/articles/10.3389/fped.2017.00283/full
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