10 year institutional experience of use of buccal mucosal grafts for complex urethral reconstruction for varied indications with its outcome
DOI:
https://doi.org/10.18203/2349-2902.isj20204142Keywords:
Buccal mucosal graft, Two stage reconstruction, One stage reconstructionAbstract
Background: The objective of the study was to evaluate long term efficacy and outcome of use of buccal mucosal graft (BMG) for urethral reconstruction in varied urologic conditions in children.
Methods: We retrospectively reviewed the medical records of 41 patients from 2009 till 2019 in our institution in which BMG was used for urethral reconstruction. Clinical findings along with surgical techniques used were noted for these patients. Postoperative outcome and complications were evaluated.
Results: Mean age was 6.8 years and mean follow up was for 4 years. Out of 41 patients, BMG for substitution urethroplasty was used in 25 cases of hypospadias, 4 cases of urethral stricture, 6 cases of 46 XY disorders of sexual disorders, 4 cases of Y-duplication of urethra, and 2 cases of redo-epispadias repair. 11 patients underwent one stage repairs with a success rate of 63% and 30 patients underwent two stage repair with a success rate of 66%. Analysis and comparison of the outcome in relation to the type of repair, meatal position and number of surgical procedures prior to BMG urethroplasty was statistically insignificant.
Conclusions: Buccal mucosa is an ideal graft substitute for urethroplasty. Two stage reconstructions has a slightly higher success rate than one stage reconstruction but the choice of the technique must be based on patients characteristics and on surgeons preference.
References
Jordan GH, Schlossberg SM. Surgery of the penis and urethra. In: Walsh PC, editor. Campbell’s urology, 8th ed. Philadelphia: Sounders. 2002;3886-954.
Tolstunov L, Pogrel MA, McAninch JW. Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endocr. 1997;84:480-2.
Xu Y, Qaio Y, Sa Y, Zhang J, Zhang HZ, Zhang XR, et al. One stage urethral reconstruction using colonic mucosa graft: An experimental and clinical study. World J Gastenterol. 2003;15:381-4.
Webster GD, Brown MW, Koefoot RB, Sihelnick S. Suboptimal results in full thickness skin graft urethroplasty using an extrapenile skin donor site. J Urol. 1984;131:1082-3.
Venn SN, Mundy AR. Urethroplasty for balanitis xerotica obliterans. Br J Urol. 1998;81:735-7.
Humby G, Higgins TT. A one stage operation for hypospadias. Br J Surg. 1941;29:84-92.
Duckett JW, Coplen D, Ewalt D, Baskin LS. Buccal mucosal urethral replacement. J Urol. 1995;153:1660-3.
Dessanti A, Porcu A, Scanu AM, Dettori G, Caccia G. Labial mucosa and combined labial/bladder mucosa free graft for urethral reconstruction. J Pediatr Surg. 1995;30:1554-6.
Burger RA, Muller SC, el-Damanhoury H, Tschakaloff A, Riedmiller H, Hohenfellner R. The buccal mucosal graft for urethral reconstruction: a preliminary report. J Urol. 1992;147:662-4.
el-Kasaby AW, Fath-Alla M, Noweir AM, el-Halaby MR, Zakaria W, el-Beialy MH. The use of buccal mucosa patch graft in the management of anterior urethral strictures. J Urol. 1993;149:276.
Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M. Bulbar urethroplasty using buccal mucosa grafts placed in the ventral, dorsal or laterasurface of the urethra: Are results affected by the surgical technique? J Urol. 2005;174:955-8.
Ransley PG, Manzoni GM. Buccal mucosa graft for hypospadias. In: Ehrlich RE, Alter GJ, editors. Reconstructive and Plastic Surgery of the external Genitalia, Adult and Pediatric. Philadelphia, PA: WB Saunders Company. 1999:121.
Haxhirexha KN, Castagnetti M, Rigamonti W, Manzoni GA. Two-stage repair in hypospadias. Indian J Urol. 2008;24:226-32.
Snodgrass W, Elmore J. Initial experience with staged buccal graft (Bracka) hypospadias reoperations. J Urol. 2004;172:1720-4.
Obaidullah, Aslam M. Ten year review of hypospadias surgery from a single centre. Br J Plast Surg. 2005;58:780-9.
Bracka A. A versatile two stage hypospadias repair. Br J Plast Surg. 1995;48:345-52.
Tolstunov L, Pogrel A. The free buccal mucosal graft for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Endod. 1996;82:613-5.
Kamp S, Knoll T, Osman M, Häcker A, Michel MS, Alken P Donor-site morbidity in buccal mucosa urethroplasty lower lip or inner cheek. BJU Int. 2005;96:619-23.
Jang TL, Erickson B, Medendorp A, Gonzalez CM. Comparison of donor site intraoral morbidity after mucosal graft harvesting for urethral reconstruction. Urology. 2005;66:716-20.
Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU Int. 1999;83:631.
