Using buccal mucosa for urethral reconstruction in primary and re-operative surgery

Urethral reconstruction using buccal mucosa grafts finds increased broader use in patients with congenital or acquired urethral defects. The authors present their experience of 20 such treated patients. 12 repeatedly operated patients (11 congenital defects, 1 war injury) showed urethral defects of 4.5-20 cm in length. In 8 patients, 6 with hypospadias and 2 with prior straightening of the penis due to penoscrotal transposition, a urethral defect length of 2.5-7 cm had to be bridged.

For 2 patients a tubularized buccal mucosa free graft was used and for 18 patients the onlay method was partly or wholly used. In 1 patient a tubularized preputial island flap was used in addition to a buccal mucosa free graft. The urethral meatus was placed at the tip of the glans in all patients.

Postoperatively a coronary fistula occurred in 1 patient. In 2 patients anastomotic strictures were seen after 18 and 60 days, respectively. One patient had a meatal stenosis and one splitting of the glans wings. With a mean follow-up time of 27 months, no further complications have been observed.

The use of the buccal mucosa graft for urethral reconstruction is a successful method with a low incidence of complications. The indications arising from this operating method should, in our opinion, lead to the increased and broader use of this treatment method for congenital and acquired urethral defects.