THE MORBIDITY OF BUCCAL MUCOSAL GRAFT HARVEST FOR URETHROPLASTY AND THE EFFECT OF NONCLOSURE OF THE GRAFT HARVEST SITE ON POSTOPERATIVE PAIN

No AccessJournal of UrologyAdult Urology: Trauma/Reconstruction/Diversion1 Aug 2004THE MORBIDITY OF BUCCAL MUCOSAL GRAFT HARVEST FOR URETHROPLASTY AND THE EFFECT OF NONCLOSURE OF THE GRAFT HARVEST SITE ON POSTOPERATIVE PAIN D.N. WOOD, S.E. ALLEN, D.E. ANDRICH, T.J. GREENWELL, and A.R. MUNDY D.N. WOODD.N. WOOD , S.E. ALLENS.E. ALLEN , D.E. ANDRICHD.E. ANDRICH , T.J. GREENWELLT.J. GREENWELL , and A.R. MUNDYA.R. MUNDY View All Author Informationhttps://doi.org/10.1097/01.ju.0000132846.01144.9fAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assess the medium and long-term morbidity of buccal mucosal graft (BMG) harvest for urethroplasty, and evaluate the effect of nonclosure of the graft harvest site on postoperative pain. Materials and Methods: A questionnaire was mailed to 110 men who underwent BMG urethroplasty between January 1, 1997 and August 31, 2002. Demographic data and side effects of BMG harvest, including oral pain, sensation and intake, were assessed postoperatively. A prospective study was then performed to compare 20 unselected men whose BMG donor site was closed with a group of 20 men in whom it was left open using a 5-point analog pain score that was completed twice daily for the first 5 postoperative days. Results: A total of 49 men with a median age of 49 years (range 23 to 73) returned questionnaires relating to 57 BMG harvests. Of the graft harvests 47 (83%) were associated with postoperative pain, which was worse than expected in 24 (51%). Of the 57 patients 51 (90%) resumed oral liquid intake within 24 hours and 44 (77%) resumed normal diet within 1 week. Postoperative side effects included perioral numbness in 39 (68%) patients with 15 (26%) having residual numbness after 6 months, initial difficulty with mouth opening in 38 (67%) with 5 (9%) having persistent problems, changes in salivation in 6 (11%) and mucous retention cyst that required excision in 1 (2%). The men in the prospective donor site study had a median age of 51 years (range 24 to 70). Mean pain score for patients with donor site closure was 3.68 and was significantly higher than that for patients without donor site closure (2.26, p < 0.01). Conclusions: Buccal mucosal graft harvest is not a pain-free procedure. Closure of the harvest donor site appears to worsen this pain and it may be best to leave harvest sites open. The main long-term complications are perioral numbness, persistent difficulty with mouth opening and change in salivary function. References 1 : The buccal mucosal graft for urethral reconstruction: a preliminary report. J Urol1992; 147: 662. Link, Google Scholar 2 : Autologous buccal mucosal graft for urethral reconstruction. Urology1994; 44: 753. Google Scholar 3 : Buccal mucosal urethral replacement. J Urol1995; 153: 1660. Link, Google Scholar 4 : When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology1996; 48: 194. Google Scholar 5 : Changing practice in anterior urethroplasty. BJU Int1999; 83: 631. Google Scholar 6 : Substitution urethroplasty with buccal mucosal free grafts. J Urol2001; 165: 1131. Link, Google Scholar 7 : Buccal mucosa grafts for urethral reconstruction. Urology1998; 51: 15. Google Scholar 8 : Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol1997; 80: 328. Google Scholar 9 : Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod1997; 84: 480. Google Scholar 10 : Regeneration of mouth mucosa in the buccal plane following graft procurement for reconstruction of bulbar urethral stenoses. Mund Kiefer Gesichtschir1999; 3: 34. Google Scholar 11 : A buccal mucosal harvesting technique for urethral reconstruction. J Urol1997; 157: 1268. Link, Google Scholar 12 : Technique of harvesting buccal mucosa for urethral reconstruction. J Urol1996; 155: 1696. Link, Google Scholar 13 : The use of buccal mucosal in urethral reconstruction. Adv Urol1995; 8: 213. Google Scholar 14 : Autologous buccal mucosal graft for hypospadias repair: an initial report. J Urol1992; 147: 1081. Link, Google Scholar 15 : Reconstruction of the urethral meatus with a buccal mucosa graft. Urol Int1995; 55: 29. Google Scholar 16 : The use of buccal mucosal patch graft in the management of anterior urethral strictures. J Urol1993; 149: 276. Link, Google Scholar 17 : Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol1997; 80: 328. Google Scholar From the Institute of Urology, University College London, London, United Kingdom© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBarbagli G, Akbarov I, Heidenreich A, Zugor V, Olianas R, Aragona M, Romano G, Balsmeyer U, Fahlenkamp D, Rebmann U, Standhaft D and Lazzeri M (2018) Anterior Urethroplasty Using a New Tissue Engineered Oral Mucosa Graft: Surgical Techniques and OutcomesJournal of Urology, VOL. 200, NO. 2, (448-456), Online publication date: 1-Aug-2018.Lacy J, Johnson S, Dugan A and Gupta S (2017) Urethroplasty Practice Patterns of Genitourinary Reconstructive SurgeonsUrology Practice, VOL. 5, NO. 3, (223-227), Online publication date: 1-May-2018.Lee Z, Waldorf B, Cho E, Liu J, Metro M and Eun D (2017) Robotic Ureteroplasty with Buccal Mucosa Graft for the Management of Complex Ureteral StricturesJournal of Urology, VOL. 198, NO. 6, (1430-1435), Online publication date: 1-Dec-2017.Lumen N, Vierstraete-Verlinde S, Oosterlinck W, Hoebeke P, Palminteri E, Goes C, Maes H and Spinoit A (2015) Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty: A Prospective Comparison of Surgical Outcome and Donor Site MorbidityJournal of Urology, VOL. 195, NO. 1, (112-117), Online publication date: 1-Jan-2016.Barbagli G, Fossati N, Sansalone S, Larcher A, Romano G, Dell'Acqua V, Guazzoni G and Lazzeri M (2013) Prediction of Early and Late Complications after Oral Mucosal Graft Harvesting: Multivariable Analysis from a Cohort of 553 Consecutive PatientsJournal of Urology, VOL. 191, NO. 3, (688-693), Online publication date: 1-Mar-2014.Terlecki R, Steele M, Valadez C and Morey A (2010) Grafts are Unnecessary for Proximal Bulbar ReconstructionJournal of Urology, VOL. 184, NO. 6, (2395-2399), Online publication date: 1-Dec-2010. (2009) Reply by AuthorsJournal of Urology, VOL. 182, NO. 3, (1235-1236), Online publication date: 1-Sep-2009.Castagnetti M, Ghirardo V, Capizzi A, Andretta M and Rigamonti W (2008) Donor Site Outcome After Oral Mucosa Harvest for Urethroplasty in Children and AdultsJournal of Urology, VOL. 180, NO. 6, (2624-2628), Online publication date: 1-Dec-2008.Whitson J, McAninch J, Elliott S and Alsikafi N (2008) Long-Term Efficacy of Distal Penile Circular Fasciocutaneous Flaps for Single Stage Reconstruction of Complex Anterior Urethral Stricture DiseaseJournal of Urology, VOL. 179, NO. 6, (2259-2264), Online publication date: 1-Jun-2008.Levine L, Strom K and Lux M (2007) Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical OutcomeJournal of Urology, VOL. 178, NO. 5, (2011-2015), Online publication date: 1-Nov-2007.Simonato A, Gregori A, Lissiani A, Galli S, Ottaviani F, Rossi R, Zappone A and Carmignani G (2018) The Tongue as an Alternative Donor Site for Graft Urethroplasty: A Pilot StudyJournal of Urology, VOL. 175, NO. 2, (589-592), Online publication date: 1-Feb-2006. Volume 172Issue 2August 2004Page: 580-583 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsbuccal mucosagraft adverse effectsMetricsAuthor Information D.N. WOOD More articles by this author S.E. ALLEN More articles by this author D.E. ANDRICH More articles by this author T.J. GREENWELL More articles by this author A.R. MUNDY More articles by this author Expand All Advertisement PDF downloadLoading ...