الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hypospadias is a relatively common congenital deformity of the urogenital system affecting approximately 0.3–0.4% of the population worldwide. The urethral opening is sited anywhere from the glans to the perineum along the ventral of the penis. The goal of the initial repair is to correct any curvature, ensuring that the penis is straight, allowing for successful intercourse, to create a functional neourethra to direct the urinary stream in a forward direction and to produce a cosmetically normal penile appearance with a slit like meatus at the tip of the glans. Although more than 300 procedures have been described in the literature, complications and failures do occur and pursuit of the ideal repair still goes on. Repeated attempts at surgical repair of hypospadias may leave the penis scarred, hypovascular and short. The term ‘hypospadias cripples’ describes the most difficult complication of hypospadias surgery. The surgical management of redo and cripple hypospadias after failed can be challenging because there is a lot of obstacles to overcome during repair of failed prior reconstruction such as significant residual curvature, scarred or absent urethral plate, shortage of skin, and lack of vascularized tissues and flaps. Staged buccal graft repair (Bracka’s technique) is an option to import fresh tissue for urethroplasty. This approach creates a well vascularized urethral plate substitute. In this prospective study we included 60 pediatric patients with failed prior repair over a period of 2 years; we applied Bracka’s technique to all patients. In the first stage, a full-thickness buccal mucosal graft was used for urethral plate reconstruction after release of chordee. Stage II was carried out at least 6 months after the first procedure. Our results showed that 36 of the 55 patients (56.4%) who completed this study had successful repair while 15 patients (27.3%) had failed repair with recurrent hypospadias due to complete wound disruption or glans dehiscence and needed another redo surgery, minor complications were reported in 9 cases (16.36%). Subsequent successful repair of fistulae was performed in those patients, increasing the overall success rate (72.3%) which was considered satisfactory.