Long-term evaluation of staged oral mucosa graft urethroplasty in children with reoperative hypospadias: functional and cosmetic outcomes during adolescence and early adulthood.

INTRODUCTION: Failed hypospadias repair remains a challenging issue in pediatric urology due to tissue loss, scarring, and complex anatomy. Oral mucosal grafts (OMGs) have become reliable options for urethral reconstruction in salvage cases. This study aims to evaluate the long-term functional and cosmetic outcomes of staged oral mucosal graft urethroplasty in children who have previously undergone unsuccessful hypospadias repairs. The goal was to assess the durability of the surgery through puberty and adolescence using standardized outcome measures. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted assessing children who underwent staged oral mucosal graft (OMG) urethroplasty between January 2007 and December 2013 at our institution. In 2024, patients were evaluated for long-term functional and cosmetic outcomes using clinical examination, uroflowmetry, the Hypospadias Objective Scoring Evaluation (HOSE) score, and the Penile Perception Score (PPS). RESULTS: The mean age at first-stage surgery was 7.9 ± 2.8 years. At a minimum of 10-year follow-up from definitive final surgery, uroflowmetry showed a functionally patent neourethra in 62 patients (91.2%), with a mean Qmax of 12.6 ± 3.4 mL/s. Bell-shaped curves were seen in 27 (39.7%), while obstructive curves were identified in 6 patients (8.8%). The mean HOSE score was 10.3 ± 1.9, and the mean PPPS score was 9.4 ± 1.2, indicating satisfactory functional and cosmetic outcomes. The most common complication was urethrocutaneous fistula, occurring in 11 patients (16.1%). Overall, complications were observed in 21 patients (30.8%), and only four patients (13%) required redo grafting. DISCUSSION: Achieving good short-term results in hypospadias repair is encouraging, but long-term follow-up into adolescence remains essential. Redo hypospadias procedures, especially in children, present unique challenges, making staged oral mucosal graft (OMG) urethroplasty a dependable choice. Long-term urinary outcomes were favorable, with most patients maintaining good flow. Cosmetic satisfaction was high regarding penile skin and urethral appearance, although dissatisfaction with penile length persisted, highlighting the need for realistic counseling. Patient-reported scores matched objective evaluations, confirming the durability of staged OMG repairs. Overall, OMG urethroplasty offers stable functional and cosmetic results, supporting its continued use in reoperative pediatric hypospadias. CONCLUSION: Oral mucosal graft urethroplasty provides excellent long-term functional and cosmetic outcomes in children with failed hypospadias repairs. The high HOSE and PPPS scores, along with a low complication rate and durability through puberty, adolescence, and early adulthood, support OMG as a preferred tissue substitute in complex reoperative hypospadias surgeries.