Buccal mucosal grafts: lessons learned from an 8-year experience

Area of Science:

• Urology
• Pediatric Surgery
• Reconstructive Surgery

Background:

• Buccal mucosal grafts are utilized for urethral reconstruction in complex hypospadias and epispadias.
• Evaluating long-term outcomes of buccal mucosal grafts is crucial for optimizing surgical techniques.

Purpose of the Study:

• To assess the 8-year experience with buccal mucosal grafts in complex hypospadias and epispadias repair.
• To identify complications and reoperation rates associated with buccal mucosal graft use.

Main Methods:

• A retrospective review of 29 patients undergoing 30 buccal mucosal graft placements for urethral reconstruction between 1991 and 1999.
• Analysis of complication types, timing, and reoperation rates, with a median follow-up of 5.3 years.
• Comparison of outcomes before and after modifications implemented in 1995, including enlarged meatal design and postoperative dilation.

Main Results:

• Overall complication rate was 57% (17/30), with reoperation in 33% (10/30) of cases.
• Complications included meatal stenosis (5), stricture (7), glanuloplasty breakdown (1), meatal breakdown (1), graft breakdown (1), and fistula (2).
• Post-1995 modifications led to a significant reduction in complications (5/15 vs. 12/15, p=0.027) and eliminated meatal stenosis.

Conclusions:

• Buccal mucosal grafts have high complication (57%) and reoperation (33%) rates at 5-year follow-up.
• Modifications in meatal design and postoperative dilation have significantly improved outcomes in recent years.
• Buccal mucosa remains a viable option for urethral reconstruction when extragenital tissue is required.