Initial experience with ‘inverted U’ staged buccal mucosa graft (bracka) for hypospadias repair

Abstract

Objective: To describe a modification of the Bracka procedure (‘inverted U’), used to enlarge the graft and diminish the risk of graft contracture compromising the subsequent urethral reconstruction. Material and methods: Inverted U Bracka procedure was performed in 10 children in whom previous hypospadias correction had failed. The surgical steps are identical to the original Bracka procedure. The only modification is reconfiguration to enlarge the graft. Results: Significant contraction of the graft was not seen in any patient and the second stage was performed uneventfully. After the second surgery there were two complications: one fistula and one wound infection. Conclusion: In this preliminary study, the modification avoided significant contracture of the graft giving a more predictable size of the neourethra for the second-stage procedure. An amplified series is necessary to confirm this initial result.