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19–22 APRIL, 2017, BARCELONA, SPAIN
S8-11 (P without presentation)
ISOGENIC FORESKIN TRANSPLANT FOR SALVAGE
REDO‑HYPSPADIAS REPAIR IN MONOZYGOTIC TWINS
Yazan F. RAWASHDEH
Aarhus University Hospital, Urology, Aarhus, DENMARK
PURPOSE
Salvage hypospadias repair procedures are restricted by the paucity of donor sites for harvest of
non-hair bearing skin and or mucosa especially when foreskin and buccal mucosa have been used
or in cases that require extensive urethral replacement.
MATERIAL AND METHODS
A 33 year old patient born with severe hypospadias and operated upon more than 20 times since
childhood, presented with urinary retention. Initial management comprised an extensive meatotomy
with removal of urethral calculi. The reconstructed urethra was severely scarred and strictured.
On follow-up it transpired that the patient had a monozygotic twin with discordance for the urethral
anomaly who was willing to donate his foreskin.
Preoperative genetic and virology testing confirmed monozygosity and excluded any infectious risk.
A standard circumcision was performed on the brother where after the index patient underwent
the first of a two stage procedure. The scarred neourethra was removed in its entirety down to
the penoscrotal junction. The resulting defect was covered with the donor foreskin. On dressing
removal 7 days later there was 100% take.
Eleven months later stage two was completed by tubularising the graft, with tunica vaginalis cover.
RESULTS
Recovery after both procedures and for both the donor and recipient were uneventful. At follow-up
6 months postop there was good cosmesis and the index patient reported being able to void stand-
ing with a good stream. There were no fistulae, break down or meatal stenosis.
CONCLUSIONS
Despite its extreme rarity, isogenic grafts can be used in hypospadias repair.